In September 2020, the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI) finalized the Radiation Oncology (RO) Model, which aims to test whether prospective, site neutral, episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD), and freestanding radiation therapy centers for radiotherapy (RT) episodes of care would reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries. The Model’s episode payment is designed “to give radiotherapy providers and suppliers greater predictability in payment and greater opportunity to clinically manage the episode, rather than being driven by fee-for-service (FFS) payment incentives.”
Radiation therapy providers and suppliers were randomly selected for participation based on Core-Based Statistical Areas (CBSAs), and 33 sites from 14 practices in The Network are included in the zip codes selected for participation.
While CMS made some minor improvements to the Model, its final rule largely dismissed provider concerns. The Network emphasized its disappointment with the final Model in a letter to CMS stating, “For years, The Network has supported the development of an alternative payment model (APM) to promote quality outcomes and provide payment stability in radiation oncology…but we feel strongly that this model was finalized on a rushed timetable during a period when providers are struggling to maintain patient access to care… Given the minimal changes made between the proposed and final Model as well as other aspects of the (payment) methodology that remain unclear, we are deeply concerned the Model will result in a payment cut to physician group practices beyond the 6% estimated in the final rule and provide no additional stability.” The Network urged CMS to delay the Model’s start date and strongly reconsider its payment methodology.
Thanks to the advocacy efforts of The US Oncology Network and other industry stakeholders, on October 21, 2020, CMS announced it would delay the Model’s start date from January 1, 2021 to July 1, 2021. Congress subsequently delayed the model’s start to January 1, 2022.
On July 19, 2021, CMS issued a revised version of the RO Model, with slight modifications, including updating the model’s base rates, removing liver cancer and brachytherapy, and lowering the discounts from 3.75% to 3.5% for the professional component and 4.75% to 4.5% for the technical component, and adopting an extreme and uncontrollable circumstances policy. The Network will submit comments on the proposed rule prior to the deadline on September 17, 2021.
To learn more about The Network’s advocacy on the RO Model: