What Would Super Committee Say About $430M Proton Beam Center War?

Cheryl Clark, for HealthLeaders Media , November 3, 2011

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.

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3 comments on "What Would Super Committee Say About $430M Proton Beam Center War?"

SneakyBooger (11/12/2011 at 7:12 AM)
It's a waste of tax payer money. 80% of the patients being treated at these proton centers will be prostate cancer patients. PROTONS HAVE NOT BEEN SHOWN TO BE ANY MORE CURATIVE THAN OTHER MODERN RADIOTHERAPY TREATMENTS; NOR ARE THERE ANY LESS SIDE EFFECTS. See the NCCN guidelines for prostate cancer at WWW.NCCN.ORG.

Mike Van Doren (11/4/2011 at 10:40 AM)
Cheryl Clark's article superbly exposes the myopic decision-making in health care by "rational individuals" who can then play opossum to the maladies, both human and financial, wrought by their decisions because they were not held accountable in the first place. Without better controls there will continue to be too many such examples of people attempting to have their cake and eat it too, without consideration of who's to pay for the cake in the first place.

Leonard Arzt (11/3/2011 at 4:06 PM)
It is ironic that on the day after the writer, Cheryl Clark, and I talked, Medicare published its 2012 proton therapy reimbursement rates, announcing a 15% bump in finalized proton therapy hospital-based rates. It also called attention to "relative stability"in determining next year's rates. This often sets the standard followed by regional Medicare carriers. So for next year, at least, the roller coaster ride remains smooth,and stable.As well as providing greater access for cancer patients nationwide. Leonard Arzt, National Association for Proton Therapy




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