by Sean Ruck
, Contributing Editor | March 22, 2019
From the March 2019 issue of HealthCare Business News magazine
HCB News: Did the recent government shutdown impact the proton therapy sector in any way?
We are not aware of any direct impact of the recent government shutdown to the proton therapy sector, but there is concern that there could be an indirect impact related to the possible delay in the release of a potential alternative payment model for radiation oncology. Last November, HHS Secretary Azar, in a public address, stated that they are “actively exploring new and improved episode-based models in other areas, including radiation oncology.” This wasn’t unexpected, but it was surprising to hear radiation oncology pointed out directly by Secretary Azar. Especially when he later shared that some of these models will be mandatory, contrary to the prior secretary’s direction. While it appears the creator of these new models, the Center for Medicare and Medicaid Innovation, was funded during the shutdown, the Office of Management and Budget was not funded and thus, any rule-making that would be released by CMMI could be delayed.
HCB News: Can you give an update on what, if any, new cancer indications have gained insurer coverage in the last 12 months?
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As I mentioned earlier, improvements have been made in coverage for esophageal and head and neck cancers with many payers. This follows increases in access for indications in two Medicare administrative contractor jurisdictions covering nine states that included esophageal, right-sided breast cancer, Hodgkin’s disease and B-Cell lymphomas. Recently, after years of advocating, UnitedHealth Group updated their proton therapy coverage policy removing language that proton therapy is unproven and not medically necessary for treating prostate cancer. These changes are all positive developments for cancer patients who would benefit from proton therapy.
HCB News: Does NAPT collaborate or partner with any other organizations?
The NAPT collaborates and partners often with other organizations on issues of which we share common interest. We often collaborate with the American Society for Radiation Oncology on issues that impact both proton and radiation therapy. The Particle Therapy Co-Operative Group – North America has been a strong partner for years, especially on the NAPT – PTCOG Proton Therapy Model Coverage Policy.
HCB News: What can attendees expect at this year’s conference?
Attendees at this year’s conference can expect a robust program that is headlined by Florida Senator Marco Rubio and a keynote address from the American Medical Association’s president, Dr. Barbara McAneny, who is going to address the growing issue of prior authorization reform and inappropriate denials. The conference program agenda covers four tracts that include improving access, clinical & business operations, patient advocacy, and growth and development in the field. This includes sessions with updates on key clinical trials, the impact of consolidation in healthcare, the future of particle therapy in the U.S., and the latest trend of bond financing in proton therapy, just to name a few.