Progress for the Field and Healthy Debate:
Reflections on my Term as ASTRO Chair
Jeff M. Michalski, MD, MBA, FASTRO
My term as the 2024 ASTRO Board Chair has passed by quickly with some notable accomplishments but not without controversy! In July, CMS released their proposed rules for 2025 Medicare reimbursements. CMS proposed no new payment cuts for radiation oncologists next year and a small increase in hospital outpatient reimbursements. However, a 2.8% reduction in the conversion factor and cuts in clinical labor will inevitably lead to continued decline in support for our physicians and their practices. This 2025 proposed rule, along with a decade of more than 23% payment cuts, continues to argue in support of ASTRO’s proposal for a legislative fix to radiation oncology payments in the form of the Radiation Oncology Case Rate Act. The program has bipartisan and bicameral support in Congress, and we are optimistic that it will move forward to enactment. Despite this favorable early support, the legislative work is far from complete. Our members must continue to advocate for the passage of the ROCR Act in order to secure stable payments for our services in the future. Be on the lookout for ASTRO communications to support the Government Relations efforts to enact these reforms!
This past spring we had a healthy debate over the expectations of physician supervision during radiation therapy services. ASTRO held a virtual town hall and created an ROhub discussion thread for ASTRO members to share their points of view. In response to feedback, we established a Supervision Work Group that consisted of a broad swath of members from diverse practices: community and academic, rural and urban, large and small. The work group acknowledged the need for direct or personal supervision for services such as simulations, stereotactic radiosurgery, stereotactic body radiation therapy, treatments involving radioactive materials, and the weekly management on-treatment visit. They recommended that general supervision be the standard for other radiation therapy services including routine linear accelerator treatments and image guided radiation therapy. Details of the Working Group’s recommendations can be found on the ASTRO website at www.astro.org/supervisionrecs. These recommendations will inform our communications with CMS. Meanwhile, CMS has proposed a return to in-person weekly management visits (77427) while extending “Direct Virtual Supervision” for other circumstances through the end of 2025. In essence, the debate on supervision expectations will continue for at least another year.
And finally, as we approach the 2025 ASTRO Annual Meeting in Washington, DC, which promises to be another exciting event in a new city, the meeting marks an important leadership transition for ASTRO. After serving 22 years as our Chief Executive Officer, Laura Thevenot will retire with over two decades of exceptional accomplishments that have advanced our Society. During her tenure, ASTRO’s membership grew 50% while she established the ASTRO PAC, founded two new journals dedicated to radiation oncology, launched the APEx practice accreditation program, and founded the Radiation Oncology Institute, to name a few. Her leadership will not be forgotten as the new CEO, Vivek Kavadi, MD, MBA, FASTRO, takes the helm. Join me in congratulating each of them as they embark on these new phases of their lives.
