Proton Center Closure Doesn't Slow New Construction

Proton Center Closure Doesn't Slow New Construction

2:24pm Oct 02, 2014
Construction is continuing at the Maryland Proton Treatment Center in downtown Baltimore. It's one of three such centers under development in the Washington, D.C., region.
Construction is continuing at the Maryland Proton Treatment Center in downtown Baltimore. It's one of three such centers under development in the Washington, D.C., region.
Jenny Gold/KHN
Construction is continuing at the Maryland Proton Treatment Center in downtown Baltimore. It's one of three such centers under development in the Washington, D.C., region.

Construction is continuing at the Maryland Proton Treatment Center in downtown Baltimore. It's one of three such centers under development in the Washington, D.C., region.

Jenny Gold/KHN

Proton beam radiation therapy has been touted as the next big thing in cancer care. The idea, enthusiasts say, is that doctors can deliver higher, more focused doses of radiation than they can in traditional therapy, with a lower risk of side effects. The massive machines, housed in facilities the size of football fields, have been sprouting up across the country for a decade.

There are already 14 proton therapy centers in the U.S., and a dozen more facilities are under construction, even though each can cost $200 million to build.

But Indiana University last month announced that it plans to close down its center in Bloomington, as reported by Modern Healthcare.

"I never thought that in my lifetime that I would see a proton center close," says Amitabh Chandra, an economist at Harvard's Kennedy School of Government, who studies the cost of American medical care.

He's surprised because until now, industry growth has been entirely in the other direction, even though there's little evidence that proton therapy is better than standard radiation for all but a few very rare cancers.

"But we do know it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology," Chandra says.

In the Washington, D.C., area alone, three proton therapy centers are under construction. One is at Johns Hopkins Medicine's Sibley Memorial Hospital in D.C. Another is at MedStar Georgetown University Hospital, and a third — the Maryland Proton Treatment Center — is slated to open at the University of Maryland in Baltimore next year.

Officials at all three institutions say they are continuing to build their centers, despite the news out of Bloomington.

But in Indiana, a review committee determined that it just wasn't worth spending the money that would be necessary to update their proton facility. One reason for the closure is that insurers have been refusing to cover the treatment for common diseases, such as prostate cancer and breast cancer. Cigna, for example, only covers proton therapy for a single rare eye cancer, says Dr. David Finley, the group's national medical officer.

"When it's used, however, for all other tumors, it's not been showing to be any more effective than other forms of radiation therapy," says Finley.

Proton beam therapy costs three to six times as much as standard radiation therapy for illnesses like prostate cancer, according to Finley. He adds that when insurers pay for expensive care that isn't any better than the cheaper options, it can increase the cost of everyone's health care.

"We said if two services offer the same result, and one is much more expensive than the other one, we're only going to pay for the one that is less expensive," Finley says.

Other major insurers, including Aetna and Blue Shield of California, have also limited what they'll cover with proton therapy.

But in Washington D.C., the hospitals building new proton therapy centers aren't deterred by these coverage decisions by insurers. In emailed statements, all three hospitals said construction is continuing. Two said that the larger population of Baltimore and the District can support a proton facility more readily than a small city like Bloomington. The third hospital said it is building a smaller, one-room center that will be more cost-effective.

One health care insurer that has not put any restrictions on proton therapy is Medicare. And Medicare pays much more for the treatment than it pays for standard radiation therapy.

"That's the problem with Medicare payment policy," says Harvard's Chandra. "It not only covers treatments that are dubious treatments;it also covers dubious treatments extremely generously."

But the doctors and researchers involved with building new proton beam facilities don't think the treatment is dubious. They point to proton therapy's potential to kill cancer without damaging surrounding tissue, and they say that it's just a matter of time before clinical trials prove that proton therapy is worth the extra money.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

Transcript

ROBERT SIEGEL, HOST:

Proton therapy has been touted as the next big thing in cancer care. It requires massive machines that are housed in facilities the size of football fields. These centers have been constructed at a rapid pace for a decade all over the country, but one proton therapy center in Indiana has unexpectedly announced that it will close its doors. Reporter Jenny Gold has more.

JENNY GOLD, BYLINE: There are 14 proton therapy centers in the U.S. and another dozen facilities are under construction. Each can cost $200 million to build. So when Indiana University announced last month that it plans to close down its facility in Bloomington, it was something of a shock.

AMITABH CHANDRA: I never thought that in my lifetime I would see a proton center close.

GOLD: Amitabh Chandra is a professor at Harvard's Kennedy School of Government who studies the cost of American medical care. He's surprised because until now industry growth has been entirely in the other direction, even though there's little evidence that proton therapy is better than standard radiation for all but a few very rare cancers.

CHANDRA: But we do know that it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology.

GOLD: In the Washington, D.C. area alone, there are three proton therapy centers under construction. One at Johns Hopkins' Sibley Hospital, another at Medstar's Georgetown Hospital and a third slated to open at the University of Maryland in Baltimore next year. All three say they are continuing to build their centers despite the news out of Bloomington.

But in Indiana, a review committee determined that it just wasn't worth spending the money to update their proton facility. One reason was insurers have been refusing to cover treatment. Cigna, for example, only covers proton therapy for a single rare eye cancer, says national medical officer Dr. David Finley.

DAVID FINLEY: When it's used, however, for all other tumors, it has not been shown to be any more effective than other forms - more standard forms of radiation therapy.

GOLD: But, he says, it can cost three to six times as much for illnesses like prostate cancer. And when insurers pay for expensive care that isn't any better than the cheaper options, he explains, it can increase the costs of everyone's health care.

FINLEY: We say, well, if two services offer the same results and one is much more expensive than the other one, we're only going to pay for the one that is less expensive.

GOLD: Other major insurers have also limited what they'll cover with proton therapy, including Aetna and Blue Shield of California. But in Washington, D.C., the hospitals aren't fazed by the insurance industry's decision. In e-mail statements, all three hospital said construction is continuing and they are confident that their centers will be a success. Two said that the larger population of the D.C.-Baltimore area can support a proton facility better than a small city like Bloomington. The third said it's building a smaller one-room center that will be more cost-effective.

One insurer that has not put any restrictions on proton therapy is Medicare, and Medicare pays much more for it than they pay for standard radiation therapy. Here's Harvard's Amitabh Chandra again.

CHANDRA: That's the problem with Medicare payment policy - is that it not only covers treatments that are dubious, it covers dubious treatments extremely generously.

GOLD: But facilities like the ones in Washington, D.C., think it's just a matter of time before clinical trials prove that proton therapy is worth the cost. For NPR News, I'm Jenny Gold. Transcript provided by NPR, Copyright NPR.

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