CMS proposes to delay start of the Radiation Oncology Model

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The Centers for Medicare and Medicaid Services is proposing to delay the start date of the Radiation Oncology Model, to a date that will be determined through future rulemaking. 

On Wednesday, CMS published a proposed rule in the Federal Register to delay the current start date of the RO Model.

The public comment period ends June 7.

The RO Model is a mandatory model that tests whether changing the way radiotherapy services are currently paid through fee-for-service payments to prospective, site-neutral, modality-agnostic, episode-based payments incentivizes physicians to deliver higher-value care. 

WHY THIS MATTERS

CMS gave no reason for the delay, but the American Society for Radiation Oncology (ASTRO) has long expressed concerns about the model's reimbursement structure.

In December, ASTRO said it continued to support a transition to value-based care, but the current CMS model needed reforms to achieve that goal. 

"Excessive cuts to radiation oncology reimbursement will force many clinics to reduce services or close, threatening patient access to life-saving cancer treatments. Worse, the impact of these cuts will have a disproportionately negative impact on clinics that treat patients from populations already underserved by the healthcare system," said Dr. Laura A. Dawson, ASTRO board of directors chair.

After Wednesday's proposed delay, Dawson said, "ASTRO remains hopeful that during this process, CMS also makes the adjustments recommended by Congress and the broad coalition of stakeholders within the radiation oncology community as we remain concerned that the model in its current form is too punitive for clinics."

She added, "We continue to believe that episodic payments for radiation therapy services have great potential to improve quality and equity while reducing cancer care costs, and we will continue to advocate for proposals that achieve these goals."
 
THE LARGER TREND

The Radiation Oncology Model aims to improve the quality of care for cancer patients receiving radiotherapy and move toward a simplified and predictable payment system, CMS said. 

The RO Model tests whether prospective, site-neutral, modality-agnostic, episode-based payments to physician group practices, hospital outpatient departments and freestanding radiation therapy centers for episodes of care reduces Medicare expenditures while preserving or enhancing the quality of care for beneficiaries. 

Since 2014, CMS has explored potential ways to test an episode-based payment model for RT services. In December 2015, Congress passed the Patient Access and Medicare Protection Act, which required the Secretary of Health and Human Services to submit to Congress a report on the development of an episodic alternative payment model for RT services. 

The report was published in November 2017. It identified three key reasons why RT is ready for payment and service-delivery reform: the lack of site neutrality for payments, incentives that encourage volume of services over the value of services, and coding and payment challenges.

The Consolidated Appropriations Act, 2021, enacted on December 27, 2020, included a provision that prohibited implementation of the RO Model prior to January 1, 2022. 

Then, in December 2021, the Protecting Medicare and American Farmers from Sequester Cuts Act included a provision that prohibited implementation of the Radiation Oncology Model prior to January 1, 2023. 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com