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John W. Mitchell, Senior Correspondent | September 12, 2017
From the September 2017 issue of HealthCare Business News magazine
"This reassures the patient that they have access to all the tools in the cancer treatment toolbox by doctors in their community," Dr. Regine said.
This level of collaboration is highly unprecedented. But it secures the volumes needed to pay for the technology. While Medicare pays for proton treatments, private insurers have taken a harder line, requiring that physicians use what they believe is less costly and equally effective conventional radiation treatments.
On this front, Regine and his staff achieved another unprecedented accomplishment. They have found a way to make proton treatment cost-neutral.
"To the best of our knowledge, we're only one of two proton centers in the country where the cost of proton therapy is neutral with other cancer radiation treatment options, instead of being up to two and a half times more expensive," he said. "Imagine how well that conversation goes with the payers."
The result, according to Dr. Regine, is that on the first evaluation 70 to 80 percent of their patients are approved by insurance companies, as opposed to 30 to 50 percent across the proton treatment community. This solves a major problem in the sector as patients often feel caught in the middle between their doctors who want to use proton therapy and insurance companies that must control costs.
Articulating value to insurers
In April, a brain cancer patient in Florida filed suit against his employer and Florida Blue for their denial of proton therapy at the Mayo Clinic after the patient had gone through four months of chemotherapy with no success. He, his family and friends came up with $200,000 in four days for the proton treatment, which the patient reports has put his cancer in remission.
This issue of patient rights is a focus for the Alliance for Proton Therapy Access (The Alliance), a nonprofit in Washington, D.C. The Alliance believes cancer patients deserve better, Executive Director Daniel E. Smith told HCB News.
