My first patient at Southwest Florida Proton Center was a 11-year-old boy with brain cancer. Proton therapy could aim radiation at his tumor precisely enough to spare the healthy brain tissue around it, but it meant getting him to treatment five days a week, for six weeks straight.
Because our center was close to his home, his family could keep that treatment schedule, and he could go to school, baseball practice, and even cheer on his beloved Red Sox at spring training.
Other patients and families may not be so fortunate: A new Medicare pricing rule is threatening the viability of community centers like ours, jeopardizing access to lifesaving cancer care.
Proton therapy is a particularly precise delivery of radiation that can reduce exposure to healthy tissue beyond what is achievable with modern X-ray therapy. That precision matters most for children, whose growing organs sit close to their tumors, and for adults with cancers near the spine, the eye, or other delicate areas where every millimeter counts.
Proton therapy is a vital part of the U.S. cancer treatment infrastructure but remains one of the scarcest: Roughly 50 centers nationwide offer it, across just 28 states. Entire regions — the Great Plains, much of the Mountain West, large stretches of the South — have none. Freestanding centers like ours were built specifically to close that gap, so patients didn’t all have to uproot their lives and fly to a handful of large centers in major cities. Cutting reimbursement to freestanding centers will make it even harder for rural patients and discourage the opening of centers where the need is greatest.
Under a proposed rule from the Centers for Medicare and Medicaid Services that could be finalized this fall, a freestanding proton center would be paid nearly 30% less than a hospital for delivering the identical treatment on the identical equipment, a gap that has nothing to do with the quality of care and everything to do with who owns the machine and where it sits. This is not just a problem for independent centers. It is a warning to any health system that wants to extend proton therapy beyond a hospital campus and into the communities where patients live.
The National Association for Proton Therapy, which represents centers nationwide, has advocated one fair, national price for proton treatment that reflects what it actually costs to deliver, rather than a patchwork of locally set rates. This proposed pricing widens the gap instead of closing it.
CMS says it wants this new pricing approach to make proton reimbursement more consistent, which is a reasonable goal. But paying substantially less for the identical treatment, based only on which building delivers it, is the opposite of consistency. If CMS’s real aim is a level playing field, the freestanding rate should rise to meet the hospital’s, not fall further behind it.
The NAPT and proton centers around the country have asked CMS to delay the rule before it is finalized this fall. That is not a request for special treatment. It is a request that Medicare pay a fair price for the same treatment, regardless of the label on the building where a patient receives it.
I spent nearly 19 years at Massachusetts General Hospital before coming to Florida, and I’ve dedicated my career to proton radiation in both academic and community settings. Any successful technology reaches more of society over time, as competition and engineering make it smaller, cheaper, and more widely available — which is exactly what has started to happen with proton therapy. Why would CMS propose a rule that pushes us back toward the old model of a few centers in major cities rather than a model where more people can access care?
YOUR NEXT CANCER SCAN SHOULDN’T DEPEND ON MOSCOW’S PERMISSION
CMS still has time to get this right, so families don’t have to bear the cost of travel, housing, and lost income for care just to pursue the right treatment for their disease.
Every patient, whether a young baseball fan with brain cancer or a patient with breast, head and neck, prostate, or other types of cancer, should have access to the precise care they need.
Dr. Shannon MacDonald is the medical director of Southwest Florida Proton Center, a former associate professor of radiation oncology at Harvard Medical School, and a former director of the base-of-skull and sarcoma services and proton therapy liaison at Massachusetts General Hospital.
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[ H/T Washington Examiner ]
