By Dr. William F. Regine, FACRO, FACR, Isadore & Fannie Schneider Foxman Chair in the Department of Radiation Oncology at the University of Maryland; and Executive Director, Maryland Proton Treatment Center
The Maryland Proton Treatment Center (MPTC) is off to a great start since opening in February of 2016 and being the first center on the east coast designed to have both Intensity modulated proton therapy (IMPT) and volumetric image guidance fully integrated throughout our facility. In addition to five treatment rooms, we have designed our preparation space (loading and unloading) to allow for the highest patient throughput.
To achieve the maximum patient capacity, we knew we had to get started early, building referral networks and working with regional payers to ensure reimbursement for our patients
Engaging and partnering with regional providers
In order to engage local partners, we felt it was important to meet face-to-face with potential partners and provide opportunities to visit our new center. We conducted 269 facility tours since 2014 for physician groups from Maryland and the surrounding region; business and community leaders; radiation oncology industry professionals; payers; the media and donors.
This has helped result in partnerships with major regional providers of radiation oncology. Georgetown University was our first partner provider, and our second partner group is WellSpan Health located in South Central Pennsylvania. We are close to signing a third partner from the northern Virginia health system and we also have plans to sign with more throughout next year.
One of the key components of this model was to build a partnership between the radiation oncologists from referring institutions and those at our center. This is designed to allow them to work side-by-side at MPTC during the patient’s treatment.
We give our partner providers access to our treatment planning system as well as remote HIPAA-compliant access to our new patient case and treatment planning review conferences. To maintain the continuity of patient care between providers, we have also established dedicated nurse practitioner roles across patient care services.
In addition, our University of Maryland radiation oncology community network is making proton therapy more accessible to the surrounding areas. A provider at each community partner practice is credentialed at MPTC. To our knowledge, we are the first site in the country with University affiliated community-based practitioners who have gone through extensive credentialing so that they may make proton therapy accessible to appropriate patients from their community region. These practices are located at four community sites in Maryland, making proton therapy truly accessible to patients in these regions.
Guidelines to determine proton therapy eligibility
Our regional provider partners will use the University of Maryland Department of Radiation Oncology Clinical Practice Guidelines to determine proton therapy eligibility. These guidelines were developed by a team of radiation oncologists, medical physicists, and dosimetrists and include input from 14 nationally recognized tumor-site specific experts. Based on published evidence and institutional experiences, the guidelines include 17 tumor-sites. Extrapolating from this, we believe that 20-30 percent of cancer patients treated with radiation therapy could benefit from proton therapy.
Engaging and partnering with payers
Two years before opening MPTC, we initiated discussions with major payers. We invited executive leadership, medical directors, and contracting officials for tours of our center and an overview of our program. We proposed a partnership that we believed would be of interest to the payers, including quarterly meetings to review the data and experience of their patients.
We developed partnership proposals that broadened their existing “local” proton therapy coverage. We also introduced “discount” pricing: with higher reimbursement rates for IMRT in Maryland and our expected high-volume center model, we were able to make proton therapy cost- neutral to IMRT.
First 100 patients
Our first 100 patients treated most commonly included brain/spine, followed by prostate, head/neck, sarcomas, lung/thoracic, GI, breast, lymphoma and GYN. Fifteen percent of the first 100 patients involved re-irradiation and 10 percent were pediatric.
Through our model of engagement of providers and payers, we are not only setting our center up for success but we are also making proton therapy accessible to more patients.