AHA supports CMS proposal to delay Radiation Oncology Model
The group supported predictable payment for radiation oncologists but said the model has been marred by payment cuts and administrative burdens.
Photo: Xavierarnau/Getty Images
The American Hospital Association supports the Centers for Medicare and Medicaid Services' proposal to delay the January 2023 start of the Radiation Oncology Model to a date determined through future rulemaking, the association told the agency today.
Commenting on the proposed rule for the model, AHA said it "strongly supports CMS' efforts to transform the delivery of cancer care. We also support the original intent of the RO Model, which was to protect access to care by ensuring fair, predictable payment for radiation oncologists. However, this important goal of the original RO Model has been marred by the incorporation of significant payment cuts and substantial administrative burdens for those participating in this mandatory model."
AHA urged the agency to consider incorporating its previously recommended changes if the model advances in the future, including "adopting a risk versus reward equation that is much more appropriately balanced."
WHAT'S THE IMPACT?
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.
The model aims to improve the quality of care for cancer patients receiving radiotherapy and move toward a simplified and predictable payment system, CMS said. It 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.
CMS gave no reason for the delay, but the American Society for Radiation Oncology had long expressed concerns about the model's reimbursement structure, saying in December that, while it supports the transition to value-based care, the current CMS model needed reforms in order to realize that goal.
"Excessive cuts to radiation oncology reimbursement will force many clinics to reduce services or close, threatening patient access to lifesaving cancer treatments," said Dr. Laura A. Dawson, ASTRO board of directors chair, at the time. "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."
After the proposed delay was floated in April, Dawson said that her organization "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
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 a report to Congress 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: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
