New Proton Beam Cancer Center Could be the Nation's Ninth

"There is no published evidence to indicate that proton therapy is detrimental to patients," Coleman said, but "when you have something that is so precise with such sharp edges, you need to make sure that it's also accurate. This requires being certain that the target is hit as planned on the computer, including accounting for the uncertainties in diagnostic imaging, reproducibility in patient setup, and internal organ motion."

Another uncertainty is whether the Centers for Medicare and Medicaid Services will change the way it reimburses for proton beam and other radiation therapies for certain cancers. CMS allows this determination by regional contractors at a local level, and policies vary across the U.S. depending on the contractor.

In April, CMS convened a meeting to determine if radiation therapy reimbursement decisions for prostate cancer—a mainstay for most of the existing proton beam installations—should be made on a national basis. And if it is made on a uniformly national basis, whether more controlled clinical trials and comparative effectiveness should first prove that proton beam therapies are better than other radiation treatments for cancer.

No decision has yet been made.

But there's a lot of money is at stake, because, so far, proton beam treatments remain among the most expensive, with 30-session sets estimated to cost about $45,000.

By comparison, conventional x-ray treatments cost $36,024; intensity modulated radiation therapy or IMRT costs $12,141; and brachytherapy or the implantation of radiation seeds implanted in or near the tumor, costs $5,484, says Jeffrey Bordok, president and CEO of APC.

According to a 2010 comparison chart by the Advisory Board Company, Medicare reimbursement alone for major radiation therapy options varies widely, from $8,917 for HDR brachytherapy, $10,667 for 3-D Conformal Radiotherapy, $11,090 for stereotactic body radiotherapy (CyberKnife), $11,321 for LDR brachytherapy, $19,299 for image guided radiotherapy or IMRT, and $28,894 for proton beam.

Bordok, however, says he is not worried that Medicare will stymie proton beam revenue streams. He notes that during the presidential campaign, Barack Obama touted the procedure and praised efforts to build a proton beam center at the University of Illinois.

And at the first of this year, he says, Medicare increased reimbursement rates across the board for most proton beam treatments by 40%. "They did it for both simple and complex treatments. They felt that for certain indications, it is effective treatment, with fewer side-effects and fewer secondary cancers."

He estimates that with Medicare, Medicaid, and private insurance reimbursement and ancillary fees, he estimates gross revenues of $150 million a year.

And it's a big plus for Scripps as well, Bordok says. "At M.D. Anderson's proton beam center, I'm told they have an 80% self-referral. They learn about proton beam treatments and just show up. Maybe they get proton treatment, or maybe surgery or chemotherapy or some other treatment. But the entire patient base grows.

"And they're also able to recruit leading-edge thinking doctors who want to take advantage of these research opportunities."

Scripps CEO Chris Van Gorder agrees. "Scripps is excited to help provide access to one of science's most sophisticated weapons against cancer," he said in a statement. "This will be an immensely valuable resource for all of San Diego County and beyond ... a major step forward, allowing us to provide the most comprehensive range of radiation therapy options available today."