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John W. Mitchell, Senior Correspondent | September 12, 2017
From the September 2017 issue of HealthCare Business News magazine
"When cancer patients are prescribed proton therapy by their doctors, too many patients are forced to battle restrictive, complex and seemingly arbitrary insurance policies and practices that make if difficult or impossible to receive timely access to treatment," he said.
In July, The Alliance launched its "Tell Insurers: Fight Cancer, Not Me" campaign. The intent of the campaign is to advocate for more transparent policies to ensure approvals, without delay, by all insurers when physician-prescribed proton therapy offers a patient the best hope for survival.
Stuart Klein, executive director of the University of Florida Health Proton Therapy Institute (UFHPTI) in Jacksonville, has been in the proton therapy industry since 2006. He said that the market has changed in the past three years, shifting from primarily prostate cancer treatments to treating patients with a wider range of cancers. According to Klein, UFHPTI currently treats more patients, including children, than any other center in the world.
"These facilities should really be regional resources," said Klein. "Some of the independent centers are trying to get in without committed clinical partners. This makes it much more difficult to secure patients and insurance contracts."
He likened it to hospitals that in the past have decided to move to Level 1 Trauma emergency departments as a competitive move, only to discover such services are resource rich and expensive to operate and often lose money. Klein also cautioned that it could be difficult to find qualified staff, from engineers to physicians, to staff proton therapy centers. In their center, for example, he said they staff with 12 to 15 certified engineers.
The manufacturer perspective
The three leading proton therapy manufacturers echo many of the sentiments of the clinicians and the health systems they serve when it comes to best practices for launching a successful proton therapy facility.
"When we see PT sites that are struggling, there are usually three common reasons," Beth Klein, president of IBA Therapy, told HCB News.
She said these causes, which can stand alone or be combined, are: unrealistic projected patient volumes (including ramp-up rate); underestimated infrastructure costs; and the lack of a true clinical partner.
