Lobbyists For Competitor Succeeded In Slashing Medicare Reimbursement; New York Patients, Hospitals Will Suffer
ROCKVILLE CENTRE, NY – New Yorkers who suffer from brain diseases – and the hospitals that provide the brain tumor treatment and other therapies they need – were unexpected casualties of Washington’s recent “fiscal cliff” deal. One of the provisions tucked into the last-minute deal provides for a 50 percent reduction in Medicare hospital reimbursement for use of “multiple source cobalt-60 radiosurgery” treatments. The reduced reimbursement went into effect April 1.
The only treatment that fits this description is done using the Gamma Knife®, manufactured by Swedish company Elekta. The Gamma Knife is an established, effective radiosurgical malignant and benign brain tumor treatment, as well as therapy for brain arteriovenous malformations (AVMs), trigeminal neuralgia (severe facial pain), and other serious neurological disorders.
As discussed in several news reports (Wall Street Journal, Huffington Post), this drastic and unexpected cut in reimbursements came about following intensive lobbying by Varian Medical Systems, a major competitor of Elekta’s. According to the Federal Register, Varian has been trying to cut Gamma Knife reimbursement at least since 2009.
“Other devices generally require multiple treatments in order to have an effect similar to that of the Gamma Knife,” said neurosurgeon Michael H. Brisman, M.D., F.A.C.S, who is affiliated with the Neurological Surgery, P.C. private practice and Co-Medical Director of Long Island Gamma Knife, which is based at South Nassau Communities Hospital, Oceanside, NY. “This will cost taxpayers more, rather than less, as was claimed. Patients and the hospitals that have made significant investments in this lifesaving technology will be the biggest losers.”
According to news reports, at least one Gamma Knife center is considering closing because of this new reality, while other hospitals may decide not to purchase this costly system.
“Hospitals that have small margins and that see many Medicare beneficiaries will be seriously hurt by this, as will Medicare patients who may be denied this procedure and get costlier treatments with more side effects, which will cost Medicare more in the long run,” said Rebecca Emerick, Executive Director of the International RadioSurgery Association (IRSA), an independent organization that represents hospitals that perform radiosurgical procedures. “These hospitals have made a significant investment in this technology for brain tumor treatment and therapy of other neurological disorders. They will also need to update the equipment and refresh the Cobalt source at some point and are unlikely to have the funds to do so.”
Until the fiscal cliff deal, Medicare reimbursed hospitals about $7,000 for a Gamma Knife treatment. At this level, Gamma Knife was still not affordable for most hospitals. Other radiosurgery devices were reimbursed at $3,500 for the first session, then somewhat less for each additional session. However, since most treatments were in five sessions, this total cost was usually considerably higher than the single session Gamma Knife treatment. Any of the radiosurgery techniques would reimburse less than the traditional twenty to thirty session radiation therapy treatments or traditional “open” brain surgery which usually requires a hospital stay of several days (radiosurgery is an outpatient procedure).
“If this law is not changed, fewer seriously ill patients who need this effective treatment will have access to it,” said Dr. Brisman.
Although Dr. Brisman directs the Gamma Knife center, he also treats patients who have these serious neurological conditions with other modalities, including Varian’s Novalis® system and Accuray’s Cyberknife®, as well as with open surgery. The Gamma Knife performs a one-day superfocused radiation session and is designed specifically for treatment of brain disorders, while the other devices also treat disease outside the brain.
“By the federal government slashing reimbursements to hospitals that offer Gamma Knife treatment — arguably one of the safest, and least expensive ways of treating patients with certain brain diseases– overall costs will likely increase,” said Dr. Brisman. For radiosurgical brain tumor treatment and the treatment of other brain disorders, “hospitals will be more likely to purchase and use linear accelerators such as those sold by Varian, which routinely use five to twenty treatments instead of one, and usually cost Medicare two to three times the cost of a Gamma Knife treatment. The government should immediately reverse this harmful decision.”
According to the news reports, Varian aggressively lobbied for a drastic cut in their competitor’s reimbursements. Varian was said to have brought their lobbying staff up to 31, many of whom previously worked for the government, and spent $570,000 on this all-out effort. As a foreign-owned company Elekta is not allowed to participate financially in U.S. elections.
The Congressional Budget Office projected that cutting reimbursement for Gamma Knife would save taxpayers $300 million.
“It’s unfortunate that Congress did not check the facts, as this will cost taxpayers over time rather than saving them money,” said Ms. Emerick. “And Medicare beneficiaries will have far less of this quality, evidence-based treatment available to them.”