Online Submissions. Follow the Instructions at This Link

SAMPLE LETTER #1 CMS LETTER TO BE PERSONALIZED: Comments must be received by CMS by 5 p.m. on Monday, August 31, 2009. Options include: . Online Submissions. Follow the instructions at this link -- http://www.regulations.gov/fdmspublic/component/main? main=SubmitComment&o=09000064809f0082 . Regular Mail. The address is provided below. Please allow sufficient time for mailed comments to be received before the close of the comment period. [YOUR NAME] [YOUR ADDRESS] [YOUR CITY, STATE, ZIP] [YOUR PHONE AND/OR EMAIL (OPTIONAL)]

[DATE] Charlene Frizzera Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS–1413–P P.O. Box 8013 Baltimore, MD 21244–8013

Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010; CMS–1413–P

Dear Acting Administrator Frizerra,

WHO YOU ARE: [Indicate that you are a radiation oncologist, where you treat, how long you have been practicing, etc.]

WHY THE ISSUE IS IMPORTANT: [Briefly describe the value and importance of radiation therapy to your patients.]

WHAT POLICY YOU ARE WRITING ABOUT: [Tell CMS you are writing to express your concern about 2010 Medicare payment rates for radiation oncology contained in the CY 2010 Physician Fee Schedule Proposed Rule.]

WHAT IS GOING TO HAPPEN IF CMS FINALIZES ITS RULE: [Inform CMS its proposed average 19 percent reduction (up to 44 percent or more) in payment for the kind of treatment you provide may force radiation therapy centers such as yours to close.]

WHAT ARE YOU ASKING CMS TO DO: [Ask CMS to refrain from finalizing the proposed reductions in Medicare payment for radiation oncology services due to a potentially faulty survey methodology and (2) discontinue the application of a higher assumed equipment utilization rate for radiation oncology equipment.]

Sincerely, [YOUR NAME] SAMPLE LETTER #2 ALTHOUGH PERSONALIZED LETTERS HAVE THE MOST IMPACT, A SAMPLE LETTER IS PROVIDED BELOW. July xx, 2009

Charlene Frizzera Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS–1413–P P.O. Box 8013 Baltimore, MD 21244–8013

Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010; CMS–1413–P

Dear Acting Administrator Frizerra, As a provider treating at [RADIATION THERAPY CENTER] in [CITY], I am writing to express my serious concern regarding the drastic reductions in the 2010 Medicare payment rates for radiation oncology contained in the CY 2010 Physician Fee Schedule Proposed Rule. It is my understanding if this rule is finalized that codes critical to the provision of radiation therapy I provide to my cancer patients could be cut by 44 percent or more. I have been treating patients as a radiation oncologist for __ years and can attest to the importance of radiation therapy as a critical treatment option for individuals diagnosed with cancer. Radiation therapy involves the use of radiation to safely and effectively treat cancer by damaging cancer cells. New and improved techniques are continuously being developed to allow radiation oncologists to better target radiation to more effectively eliminate cancer cells and protect healthy cells. Unfortunately, it is my understanding the proposed rule may contain a faulty data methodology utilized in the Physician Practice Information Survey (PPIS) and incorrectly applies an equipment utilization factor that does not distinguish between diagnostic and therapeutic modalities. In the rule, CMS proposes to change the utilization rate (from 50 percent to 90 percent) for equipment over one million dollars. This policy stems from concerns raised by the Medicare Payment Advisory Commission (MedPAC) and others regarding the volume growth of diagnostic imaging services over the past several years. CMS even cites a March 2009 MedPAC report in its discussion on diagnostic imaging and the equipment utilization policy, but then inexplicably applies the equipment utilization policy to radiation therapy. However, there is a clear distinction between radiation therapy and diagnostic imaging. Radiation therapy occurs only after a cancer has been diagnosed and the radiation used to guide such therapy is not diagnostic in nature. This policy appears to be responsible for at least a quarter of the total cut to radiation therapy in the rule. In addition, the incorporation of new practice expense survey data exacerbates the reduction that would be caused by modifying the assumed equipment utilization rate for radiation oncology equipment. As a result of the incorporation of this survey data, it is my understanding that CMS is proposing to eliminate 50% of all medical equipment and other direct costs from the rate-setting formula. As a consequence, CMS is proposing to decrease Medicare payment for radiation oncology treatment, even though the AMA’s recent practice expense survey suggests that radiation oncology practice expenses have remained relatively stable or experienced modest increases. This policy appears to be responsible for approximately two- thirds of the total cut to radiation therapy in the rule. In sum, as a result of these and other technical aspects of the rate-setting methodology, the CY 2010 Physician Fee Schedule Proposed Rule would have a devastating impact on radiation oncology. The overall impact from the rule is a 19 percent reduction for radiation oncology in aggregate and, again, some codes critical to the provision of radiation therapy in freestanding centers could be cut up to 44 percent. Clearly, cuts of this magnitude could force many freestanding radiation therapy centers such as mine to close their doors and significantly curtail patient access to radiation therapy. Please (1) refrain from finalizing the proposed reductions in Medicare payment for radiation oncology services and conduct a thorough review of a potentially faulty data methodology and (2) discontinue the application of a higher assumed equipment utilization rate for radiation oncology equipment. Thank you for your consideration of this issue of critical importance to cancer patients.

Sincerely,