Cancer center gets reprieve on rule

A new federal requirement that could have caused serious problems for the Hi-Line cancer center in Havre has been delayed for a year, with rural and small-treatment center representatives being added to the panel that will review the requirement.
 
“This is a step in the right direction,” Northern Montana Health Care Foundation Executive Director Christen Obresley said this morning.

The U. S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services had set a requirement in its 2012 regulations that a radiation oncologist must be present when a patient receives radiation treatment.

At the Hi-Line Sletten Cancer Center in Havre, a satellite of the Sletten Cancer Institute in Great Falls, cancer patients now travel to Great Falls, where an oncologist sets their treatment program and where they receive their first treatment. Subsequent treatments are at the Havre center.

Sen. Jon Tester, D-Mont, sent a letter Oct. 5 to Health and Human Services Secretary Kathleen Sebelius, saying the rule would harm rural centers in general and the Havre Sletten Center in particular.

“In rural areas such as Montana, clinics operate as satellites for fully staffed cancer centers in order to provide care in regions where … having a radiation oncologist on-site is not feasible, ” Tester wrote. “If patients needing radiation therapy can’t continue to use these satellite clinics, they will be be forced to drive an additional 115 miles each way for treatment. This will further exacerbate health disparities that are already present. ”

Tester requested that Sebellius implement a permanent rural exemption, specifically that facilities more than 50 miles from another cancer treatment facility be allowed to provide radiation treatment without an oncologist on-site.

In her reply to Tester, dated Dec. 27, Sebelius said the final rule would extend the “nonenforcement” of the requirement a radiation oncologist be present for facilities with 100 or fewer beds through the calendar year.
Sebelius said the panel that would review the regulations will be revised to include two representatives of small rural hospitals and two representatives of critical access hospitals, facilities certified to receive cost-based reimbursement from Medicare.

“Please know I share your concern for assuring access to health care services in rural areas and will continue to strive to achieve the appropriate balance between ensuring safe, quality care in all settings and recognizing the staffing challenges that rural facilities face, ” she wrote to Tester.

In Tester’s release announcing the extension of nonenforcement of the regulation in the Havre center, Northern Montana Hospital CEO and President Dave Henry praised Tester for his work on the issue.

“Those of us along the Hi-Line appreciate Senator Tester’s support to ensure that we can continue providing critically needed services to our friends and neighbors in rural Montana, ” Henry said in Tester's release.

“His willingness to help maintain full service at the Hi-Line Sletten Cancer Center is critical for maintaining access to complete cancer treatment on the Hi-Line. ”

Obresley said this morning that continuing to offer the services with an oncologist on-site would be difficult.

“It would be a very expensive endeavor, ” she said.

She added that she believes having the rural hospitals and critical access hospitals on the panel could help with the issue. The Health and Human Services officials overseeing those services truly want to understand rural areas and set policies that will work there, but until they experience working in a rural or frontier area, and the challenges health care facilities face in those areas, it is difficult for them to comprehend, Obresley said.