Pro­ton ther­apy cen­ter clo­sure could be sign of the times

Modern Healthcare - - REGIONAL NEWS - —Jaimy Lee

The In­di­ana Univer­sity Health Pro­ton Ther­apy Cen­ter will close in De­cem­ber, mark­ing the first time a pro­ton-beam ther­apy cen­ter in the U.S. has shut its doors since the rapid pro­lif­er­a­tion of the costly treat­ment cen­ters be­gan a decade ago.

Univer­sity ex­ec­u­tives and an in­de­pen­dent re­view com­mit­tee at­trib­uted the cen­ter’s fi­nan­cial losses to a range of is­sues, in­clud­ing the cost of main­tain­ing its ag­ing cy­clotron. But the com­mit­tee also sug­gested the in­dus­try may be on the verge of a “pro­ton bub­ble” as the cen­ters strug­gle to serve a suf­fi­ciently large pa­tient pop­u­la­tion.

Many cen­ters have based their vol­ume ex­pec­ta­tions on treat­ing prostate can­cer pa­tients. But in­sur­ers have started to push back on pro­vid­ing pro­ton ther­apy cov­er­age to those pa­tients be­cause of in­suf­fi­cient ev­i­dence prov­ing its su­pe­rior ben­e­fits over other treat­ments.

“I look at this clo­sure as a sign that in­sur­ers are fi­nally em­pow­ered to say this is a du­bi­ous med­i­cal tech­nol­ogy” in the treat­ment of pa­tients with prostate can­cer, said Amitabh Chan­dra, di­rec­tor of health pol­icy re­search at the Har- vard Kennedy School of Gov­ern­ment. “The ‘build it and they will come’ phi­los­o­phy around th­ese cen­ters is be­ing ques­tioned.”

The IU cen­ter, lo­cated in Bloom­ing­ton, was the third pro­ton ther­apy fa­cil­ity in the the U.S. when it opened in 2004. It’s jointly owned by the In­di­ana Univer­sity Re­search & Tech­nol­ogy Corp., a not-for-profit that han­dles IU-re­lated business de­vel­op­ment, trade­marks and in­tel­lec­tual prop­erty, and IU Health, an In­di­anapo­lis-based health sys­tem that owns 15 hos­pi­tals in the state.

When faced with the prospect of spend­ing mil­lions to up­date the cen­ter’s equip­ment, the univer­sity called for an in­de­pen­dent re­view of the fa­cil­ity. The re­view panel unan­i­mously rec­om­mended clos­ing the cen­ter. The com­mit­tee’s re­port high­lighted is­sues af­fect­ing the pro­ton in­dus­try, in­clud­ing the lack of com­pleted ran­dom­ized clin­i­cal tri­als, im­prove­ments in al­ter­na­tive treat­ments, chang­ing care pat­terns for pa­tients with prostate can­cer, and the rise in new pay­ment mod­els, such as bun­dled pay­ments, that may re­move in­cen­tives to use the ther­apy.

The Bloom­ing­ton, Ind.-based cen­ter is clos­ing in De­cem­ber.

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