Although provider status per se applies only to reimbursement, it has far reaching ramifications within the
health care community. Absence of provider status prevents medical physicists from being considered as
professionals or part of the (treatment) team. In most cases they are not even members of the medical staff. Such
low professional standing limits the authority of physicists in using their best professional judgment for patient
care.
Medical physics services are not adequately reimbursed or recognized
Unfortunately, Medicare legislation did not allow the Healthcare Financing Administration (HCFA), now Center for
Medicare and Medicaid Services (CMS), to re-direct payment for physics services to clinical oncology physicists.
Only providers are permitted to get paid directly for their work, and physicists were not providers. Since there
was no longer a professional associated with the physics services, reimbursement started to disappear. There are
currently only two services remaining that are recognized by CMS as physics services, described by CPT codes 77336
and 77370. Reimbursement for these two codes is paid to the institution where those services are performed, not the
physicist who provides them, and covers only a small fraction of the actual cost. This puts hospital administrators
into a bind, as they have to struggle to pay for services that are not adequately reimbursed.
Professional authority and status of the medical physicist
How many cases do we all know, or hear about, where a clinical radiation oncology physicist
provides a lower standard of physics quality to meet an unreasonable deadline? This may one of the reasons behind
the results of a recent publication by the RPC [1] that shows that a substantial fraction of radiation
oncology facilities fail to pass a simple test of agreement between planned and delivered dose. An article in the
New England Journal of Medicine [2] suggests that the lower number of medical physicist hours per patient may be
contributing to the lower survival rate of cancer patients in Florida. Is this caused by hospitals treating the
clinical radiation oncology physicist as an added expense to delivering radiation treatment, therefore opting for
the least qualified physicist? Surely, Provider Status would reduce, if not eliminate, this and similar
situations.
With all its advanced science and technology, the US is behind France when it comes to five year survival for
all types of cancer [3]. One reason patients in France are doing better may be traced to the requirement, by French
regulators, for a physicist to be present for radiation treatments to be delivered [4]. In other words, the poor
use of our superior technology is beginning to show and healthcare policy scholars are currently questioning the
need to keep reimbursement levels where they currently are [5]. There is no doubt that provider Status will
increase the likelihood of a physicist being present during radiation treatment in the US. This in turn will
improve the quality of care.
How many hospitals and free standing clinics have their physicist involved with the decision to purchase major
equipment in radiation oncology today? It is happening less and less with a direct impact on quality care. When a
physicist is not involved, unsafe equipment is often purchased based on the promises of a good salesmen, rather
than its merits, and at a high price. The consequences of which can be tragic for the patient, the clinic and the
physicist him/herself. Provider Status will reverse this trend by making administrators aware of the need to
involve the proper professional at the right time.
