Medicare cuts will make radiation therapy impossible for many cancer patients

Dr. Ronald Dorn,  radiation oncologist
at Mountain State Tumor Institute

The CMS has proposed payments for Medicare patients for radiation therapy for cancer be cut  by an average of 20% beginning in January 2010.   Radiation therapy is critical in the fight against cancer. I spoke with , Dr. Ronald Dorn,  a radiation oncologist with the Mountain States Tumor Institute in Boise, Idaho to ask him how these proposed cuts would impact his practice and his patients.

Question: Dr. Dorn, how long have you been a radiation oncologist?

I have been a radiation oncologist for 31 years and for the last 26 years I have practiced in Boise, Idaho.

Question: You’ve heard about the proposed cuts to Medicare payments for radiation therapy, how will that impact your practice and your patients?

When I first came to Idaho 26 years ago there was one cancer center in Boise.  Idaho is a very large state and patients who lived in out lying areas had to travel hours to get to our cancer center in Boise. Asking a sick patient to drive 2-3 hours to reach a cancer center, have a treatment and then drive another 2-3 hours to get back home was just unacceptable.

We expanded Mountain States Tumor Institute (MSTI) to include 5 community treatment centers throughout southwest Idaho. In conjunction with St. Luke’s we became a regional leader in cancer treatment.  We are very proud of the fact that we can provide leading edge care to thousands of cancer patients each year at clinics in Boise, Fruitland, Meridian, Nampa, and Twin Falls.

I am afraid that the cuts being proposed by Medicare will force us to close some of the community based outlying clinics. The Fruitland facility, for instance, is near the Oregon border. Some patients are already driving up to an hour to reach the Fruitland center.  One of our patients is a retired school teacher.  She has breast cancer which could be cured with radiation therapy.  If the Fruitland center closes the next closest facility would be almost 2 hours away.

Radiation therapy has to be done 5 days a week for about 6 – 8 weeks. I am afraid that if our Fruitland center closes this patient might have had to choose between a mastectomy or expensive travel costs to cure her cancer. I don’t think that’s a choice anyone should have to make.

Question:  Will all your outlying centers have to close if these cuts are enacted?

No, I don’t think we would have to close all of them., at least,  I hope not.   Decisions will be based on a number of items including the mix of patients we have at each center.

Our Boise Center is quite large.  It has a divergent mix of patients   We treat those who have private insurance, Medicare and Medicaid.  It has always been our policy not to turn away anyone who has cancer even if they do not have insurance and cannot pay.

Question: If your community centers are already in operation why would a 20% reduction in Medicare payments force you to close some of them?

It is true we have already invested in the technology and equipment we need at the community centers but capital investment is not the same as operating costs. We need to maintain a staff of well qualified nurses and technicians as well as support personnel at each location. Operating expenses are very high. For instance, people do not realize that just the power bill to maintain this equipment is enormous.

Our centers do not just do radiation therapy.  They are full service cancer centers that also do chemotherapy, breast screening and treatments and pediatric oncology  where our clinics are staffed by experts in caring for children along with our three pediatric oncologists. 

Question: Since there are so many treatments for cancer, how many cancer patients would really be effected by losing funding for radiation therapy?

We have found, and I believe national statistics bear this out, two-thirds of all cancer patients will need radiation at some time during their treatment.  And while some cancers could be treated, although less humanely, without radiation many would just die.

Dr. Dorn with breast cancer patient

Breast cancer for instance could be treated by performing a radical mastectomy. This is not a pleasant option for women who could be treated effectively with just radiation but at least it is an option.   Some forms of cancer can’t be treated with alternative methods.  Certain types of cancer must be treated with radiation.

Radiation oncology helps so many people survive cancer. I can see no possible logic in forcing cancer centers to close, or consolidate so far away from many of their patients, that getting to treatment would be impossible.   We are being asked to chose between unacceptable alternatives: closing our community centers, laying off staff, using out dated equipment or refusing to see Medicare patients. Who can make that choice?  Should anyone be asked to?  Would you want to make that choice if a loved one required radiation treatment?

Thank you for your time, Dr. Dorn.