Medicare is expected to pay most of the cost, about $55,000 for one patient's course of treatment, plus $15,000 in physician fees.
The Scripps leadership team was so concerned about the financial risks, Van Gorder says, that Scripps refused to finance the project itself. So it is partnering with Advanced Particle Therapy, (APT) LLC of Minden, NV, which bought the seven-acre site and financed the 102,000-square foot, three-story construction, backed by venture capital investors.
Scripps Clinic Physicians Group and Scripps Health will oversee the medical operation under a management contract, will allow the use of its name, and supply the operations team of 135 people. Scripps does not expect to share in any profit, if there is any to be had.
This leads to the bottom line issue: reimbursement. There are questions about whether major payers will cover it and to what extent. After several days of meetings last year, the Centers for Medicare & Medicaid Services' MEDCAC (Medicare Evidence Development & Coverage Advisory Committee) opted against adopting a national coverage decision to reimburse for proton or any other treatments for prostate cancer because experts vehemently disagree which works best.
In effect, that means whether you get proton beam therapy depends on regional Medicare contractors in whatever part of the country you live in and/or whether you have an accepting supplemental insurance carrier. Blue Cross Blue Shield of Wisconsin, for example, is one that is considering not covering proton therapy for prostate cancer, according to Leonard Arzt, executive director of the National Association for Proton Therapy.