To Beam Or Not To Beam

April 27, 2008
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LANSING — Spectrum Health is undecided whether it would join a consortium on the verge of being created to bring to Michigan the most expensive piece of medical equipment ever invented.

Just don’t expect a $159 million proton beam therapy center, like the one Beaumont Hospital wants, to land in Grand Rapids.

“If the question is would you want one here, the answer is absolutely not,” said John Mosley, Spectrum Health’s senior vice president for strategy and business development. “It wouldn’t make sense to have a proton beam accelerator in Grand Rapids under any circumstances.”

A special meeting has been set for Wednesday for a final vote by a state commission charged with overseeing major medical equipment purchases. The Michigan Department of Community Health’s Certificate of Need Commission last month gave a preliminary OK to a plan to gather the state’s busiest radiation oncology centers into a consortium that would buy and operate a proton beam therapy center. There are five currently operating in the U.S., including one owned by Indiana University in Bloomington, Ind.

Michigan’s eight busiest radiation centers would be part of the consortium. The radiation units at Spectrum’s Butterworth and Blodgett hospitals combined — as they will be with the June 30 opening of the Lemmen-Holton Cancer Pavilion — would rank as the seventh busiest, according to a 2006 MDCH survey.

Beaumont Hospitals, which owns three facilities in suburban Detroit, in March filed a letter of intent to install a $159 million proton beam therapy center by 2010 in a partnership with manufacturer ProCure Treatment Inc. The letter from Beaumont, Michigan’s busiest radiation therapy center, was quickly followed by similar requests from the Barbara Ann Karmanos Cancer Institute and Henry Ford Hospital, both in Detroit, and the University of Michigan Hospitals in Ann Arbor.

“We’ve had four (hospitals) file for a Certificate of Need. That would bring $600 million in additional health care costs to Michigan which are not necessary,” Mosley said.

Proton beam therapy has been around for several decades, said Tewfik Bichay, a medical physicist at Saint Mary’s Health Care. Bichay provided comments on behalf of Saint Mary’s owner, Trinity Health, for the CON Commission’s public hearing.

Unlike radiation therapy, the proton beam “is not just energy, it’s actually a physical particle,” Bichay explained. The advantage is that the proton beam can be targeted on a tumor and stop there, sparing nearby healthy tissue and avoiding the creation of additional tumors. But there’s scant clinical evidence that proton beam therapy is effective, he said. No study has proven that proton beam therapy controls tumors, improves survival or is any less toxic than radiation therapy in prostate cancer, its most common use, according to a report submitted to the CON Commission by Dr. Marc Kashishian of Blue Cross Blue Shield of Michigan, who chaired a group that studied the issue.

Kashishian’s report cited a 2007 study that found the average cost of proton beam therapy was $58,610, compared to $25,846 for radiation therapy.

“Even the best radiation therapy machine on the market today is in the range of $2 million to $3 million,” Bichay added. “And if you’re looking at a very average proton therapy unit, you’re looking at $100 million. You’re certainly not getting 30 times better the treatment.”

Lody Zwarensteyn, president of West Michigan health planning agency Alliance for Health, praised the CON Commission’s decision to create a proton beam consortium.

“I have to salute the CON Commission for its approach,” he said. “They are saying that because there is promise, we don’t want to deny this for the state of Michigan. On the other hand, because of the cost, the appropriate way to introduce this technology would be the consortium effort.”

Dr. Frank Vicini, chief of oncology at Beaumont, said the hospital fears the proposed regulations would create a rudderless group that would become mired in self-interests and in the end would be unable to build a proton beam center. “We want a model that works,” he said.

“If the standards review says we have to collaborate in some other fashion, we believe in protons and we’ll do what we need to do to bring protons therapy to patients in Michigan,” Vicini added.

Although the controversy is centered in Southeast Michigan, it threatens to encompass both Spectrum Health and the West Michigan Cancer Center in Kalamazoo because of the way the regulations would require participation of the eight busiest radiation centers in the consortium.

Zwarensteyn said it will be up to state health department regulators to decide whether radiation therapy counts for Butterworth and Blodgett hospitals would be combined to give Spectrum Health enough to become a consortium member. He said it’s also uncertain what would happen if a qualified radiation center declined to participate.

Vicini said Spectrum Health declined Beaumont’s offer to become an equity partner in the project. He said one other organization has expressed interest, but declined to name it. He acknowledged that even though insurance reimbursements are high for proton beam therapy, the investment is risky and there’s no guarantee of breaking even.

“At this time, Spectrum is not working with us to try to develop some type of collaboration,” Vicini said. “An offer directly made from our CEO was very nicely declined.”

Mosley said Spectrum Health is wary of the cost of participating in the proposed CON-mandated consortium.

“It’s very preliminary at this point and we haven’t made a decision,” Mosley said. “The level of investment is obviously a major factor. We have other opportunities, other commitments, and we’re not sure that would meet our threshold for making that kind of investment, particularly with our doctors not necessarily clamoring for this.”

Beaumont President and CEO Kenneth J. Matzick urged the CON Commission to reject the consortium plan and to allow Beaumont’s plan to move forward. In a statement submitted to the commission in advance of Wednesday’s meeting, he touted a Beaumont proton beam center as an economic boon to the Detroit area, contending it would create 500 jobs and generate $22 million to $32 million for local businesses catering to patients traveling to Detroit for treatment.

“It’s a possibility and a probability for the state of Michigan,” Zwarensteyn added. “The technology has a great many promises.”

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