A little-noted feature of the recent U.S. budget law gives a break to radiation therapy providers.
The Medicare implications of the budget bill passed and signed into law on February 9 – especially those that affect the merit-based incentive payment system (MIPS), the work geographic practice cost index (GPCI) and the therapy cap -- have been extensively covered by Part B News, among others.
But some other features of the new law that have been less well covered nonetheless have an impact on thousands of providers and their co-workers. For example, the law extended through 2019 a reimbursement rate freeze for freestanding radiation clinics that was due to expire at the end of this year.
The freeze -- Neal Shore, MD, president of the Large Urology Group Practice Association (LUGPA) explains -- was a response by Congress to industry and patient group outrage at “draconian” reimbursement cuts on certain radiation therapy services proposed by Medicare in its practice expense (PE), malpractice (MP) relative value unit (RVU) adjustments for the 2016 final physician fee schedule, published on Nov. 16, 2015. As Part B News reported at the time:
In 2016, the most striking change is for radiation therapy centers, for which allowed charges had been estimated to increase in 2015 by 10% but will be reduced by 1% in 2016, dropping allowed charges in that category from $57 million to $52 million. This is based on a PE drop of 2% caused by CMS changes in reimbursement affecting these providers, which will result in lower payments for use of certain radiation therapy equipment.
Just a few weeks later, Congress passed the Patient Access and Medicare Protection Act, which included a freeze on the cuts through 2018. The freeze was meant to end when radiation therapy payment moved to an Episodic Alternative Payment Model – a transition still being considered but without a due date. The “Transitional Payment Rules For Certain Radiation Therapy Services Under The Physician Fee Schedule” section of the recent budget bill extends that freeze to the end of 2019.