On April 2, 2013, President Obama announced the new Brain Research through Advancing Innovative Neurotechnologies, or BRAIN, initiative. Yet even as he did this, patients suffering from brain cancer and other brain disorders may lose access to a vital therapy due to significant Medicare payment reductions.
Tucked away in section 634 of the “fiscal cliff” law, is a provision mandating that Medicare reduce hospital outpatient payment rates for Cobalt-60-based stereotactic radiosurgery, or Gamma Knife, to equal those of linear accelerator-based radiosurgery — despite significant cost differentials between the two technologies. Overall, the provision will cut hospital reimbursement by $300 million, decreasing the per treatment Gamma Knife reimbursement from approximately $8,100 to $3,400 — a 58 percent reduction.
Stereotactic radiosurgery was pioneered by neurosurgeons and is a procedure that utilizes externally generated ionizing radiation to inactivate or eradicate defined targets in the brain or spine without the need to make an incision. It is used to treat patients with serious brain disorders, including brain tumors, arteriovenous malformations, pituitary adenomas and trigeminal neuralgia. Neurosurgeons perform radiosurgery using linear accelerators, particle beam accelerators, and Gamma Knife units. The Gamma Knife is used to treat roughly 15,000 cases each year — 40 percent are benign tumors and functional indications and 50 percent are malignant tumors, with metastatic tumors comprising the majority of such cases.
Reacting to these arbitrary cuts, on March 4, 2013, organized neurosurgery sent a letter to all Members of Congress urging them to restore the Medicare hospital outpatient payment rates for Gamma Knife stereotactic radiosurgery to those in place prior to the enactment of the American Taxpayer Relief Act, so as to preserve patient access to this modality of radiosurgery. In the letter, the AANS and CNS also pointed out that in making these cuts, Congress completely ignored the Centers for Medicare and Medicaid Services’ (CMS) recent policy pronouncements on this topic. To wit, the final Medicare Outpatient Prospective Payment System rule issued on Nov., 15, 2012, CMS fully considered and rejected a proposal to establish payment parity between Gamma Knife and LINAC radiosurgery stating that because the mean costs differ significantly it would be inappropriate to pay the same for both technologies.
“Neurosurgeons must have the full range of options at their disposal to effectively treat patients with serious brain disorders such as brain tumors,” said Dr. Mitchel S. Berger, president of the AANS. “We are very worried that with cuts of this magnitude, patients with brain cancer and other neurologic diseases will lose access to this important therapy.”
“It is particularly frustrating that Congress made this change at the eleventh hour, without any input from patients and providers, and in direct contravention to CMS’ own findings,” added Ali Rezai, president of the CNS. “Patients with serious brain disorders deserve better.”
Mr. President, and Members of Congress, let’s not turn the clock back on the progress we have made in treating patients with serious brain disorders. Rather, let’s move forward and make sure that patients have access to therapies for treating these devastating neurologic diseases.
