November, 2014


By Michael J. Katin, MD

Many of the us paused on April 11 this year to mark the 773rd anniversary of the Battle of Mohi, which opened the way for Europe to be overrun by the army of Batu Khan, grandson of Genghis Khan. The Mongols had already mopped up China and Eastern Europe and now there would be nothing left to stop them from continuing westward. Just as conquest seemed inevitable, the Great Khan Ogedei died on December 11, 1241. The Law of Yassa required Batu Khan and the other Princes of the Blood to convene in Karakorum to elect the next Great Khan. The invasion never proceeded, or else today our culture might be considerably different.

Probably fewer of us paused on October 14 to mark the 102nd anniversary of the close call experienced by former president Theodore Roosevelt, Jr., as an assassination attempt by John Flammang Schrank (why do they always have three names?) was unsuccessful. Mr. Roosevelt was preparing to deliver a campaign address in Milwaukee, Wisconsin, when he was shot at close range by Mr. Schrank. The bullet passed through a metal eyeglass case and a 50-page manuscript of Mr. Roosevelt's speech before lodging in his chest. Mr. Roosevelt delivered the speech (presumably with some holes in the continuity) and then sought medical attention. The former president had to cut back on the remainder of the campaign and came in second to Woodrow Wilson although ahead of incumbent President William Howard Taft (also three names). Interestingly, Mr. Roosevelt finished third in the state of Wisconsin, indicating that he might as well have skipped that venue. Mr. Schrank was declared insane and died in the Central State Mental Hospital (later the home of Wisconsin native son and renowned serial killer Edward Theodore Gein) in 1943.

Earlier this year was the 53rd anniversary of the nearest the United States has come to a nuclear explosion. On January 23, 1961, a B-52 bomber broke up over North Carolina and dropped two four-megaton hydrogen bombs, both of which failed to detonate. This would have changed the course of world history, as James and Deloris Jordan were living in Wilmington, North Carolina, preparing for the birth of Michael Jordan on February 17, 1963.

And now for, perhaps, the closest close call of them all. On October 31, 2014, Halloween delivered an enormous treat rather than a trick when CMS released its 2015 Fee Schedule. Every expectation had been for at least one of two megatorpedoes to hit. First, construction and maintenance of the vault was no longer to be considered an expense (!), one of the components contributing to an 8% decrease in allowable charges for a freestanding radiation oncology center. This is after 20% in cuts sustained over the past 5 years! Second, this was to be the last year that decisions on the fee schedule finalized in October/November would not need to be described in the proposed rule published in July. It was therefore possible that new codes could be established and valued without any opportunity whatever for comment.

It was highly possible that the fee schedule for 2015 would have been lowered to the point that the majority of freestanding radiation oncology centers would no longer have been able to remain solvent. Considering that the directive at CMS is to reduce Medicare expenditures by $120 billion over five years, it would be advantageous to wipe out as many treatment facilities as possible.

We will never know the exact combination of events that resulted in freestanding radiation oncology's having been spared to treat another day, but many patients and their relatives, patient support organizations, dosimetrists, therapists, physicists, nurses, administrators, consultants, and physicians put untiring effort into expressing their feelings to their representatives in Congress and in meetings with CMS officials. Since we don't know any other way to do this, we will need to start the process all over again in order that we do not have any unpleasant surprises when the proposal for 2016 comes out in July. And then again for 2017, 2018, 2019, and as long as it takes.

At least until 2032, when we'll have to hope for another last-minute reprieve.