CMS plans to implement an alternative
mandatory payment model for radiation
oncology

CMS to unveil mandatory payment model for radiation oncology

November 09, 2018
by John R. Fischer, Staff Reporter
In the next few weeks, the Centers for Medicare and Medicaid Services (CMS) plans to implement an alternative mandatory payment model for radiation oncology.

The idea for the new model, announced this week, ties in with the government's assessment of bundled payments rather than separate ones for individual services and procedures, and partially stems from the success of the Bundled Payments for Care Improvement model (BPCI) in several common inpatient episodes, including joint replacement and pneumonia. HHS' recently launched version, BPCI Advanced, currently consists of more than 1,000 participants that are receiving episode-based payments for over 30 clinical areas.

Though participation is voluntary, Secretary of Health and Human Services Alex Azar says the implementation of a mandatory model is essential for determining which approach provides the most savings and greatest quality of care.

“Real experimentation with episodic bundles requires a willingness to try mandatory models,” he said Thursday in a speech at the Patient-Centered Primary Care Collaborative conference in Washington, D.C. “We know they are the most effective way to know whether these bundles can successfully save money and improve quality.”

Such experimentation is part an aim to create a simplified system that tamps down regulations, such as staffing ratio requirements and the burdensome task of individually reimbursing for each procedure or prescription, and focus more on pursuing optimal outcomes, with HHS planning to work with a variety of stakeholders to achieve these objectives. It has already started with the recent launch of a mandatory Medicare Part B model that seeks to reduce spending on drugs issued in hospitals and doctor's offices, and align U.S. payments for pharmaceuticals with those of other countries.

Though a majority of oncologists advocate for an alternative payment model, particularly due to the shift toward value-based care, many oppose the establishment of mandatory ones, seeing them as downside risks that subject Medicare patients to untested approaches with unknown results following treatment, all for the sake of lowering healthcare costs. They also argue that such models lack enough evidence to prove their worth.

While expressing its concern over this detail, the American Society for Radiation Oncology applauded Azar and CMS for the development of a radiation oncology alternative payment model (RO-APM), offering its expertise and support in the creation and implementation of one.

“ASTRO believes it is important to acknowledge that any radiation oncology payment model will represent a significant departure from the status quo. Care must be taken to protect access to treatments for all radiation oncology patients and not disadvantage certain types of practices, particularly given the very high fixed costs of running a radiation oncology clinic,” CEO Laura Thevenot said in a statement. “ASTRO is committed to working with Secretary Azar and CMMI to ensure payment stability for radiation oncology practices and the highest quality of care for people who need radiation therapy services.”

The use of mandatory models does not necessarily do away with voluntary ones all together. In addition, HHS has “reexamined” its decision to reduce the size of the Comprehensive Care for Joint Replacement, and plans to revisit the use of two mandatory cardiac care models shut down last year by the government.

“We intend to revisit some of the episodic cardiac models that we pulled back, and are actively exploring new and improved episode-based models in other areas, including radiation oncology,” said Azar. We’re also actively looking at ways to build on the lessons and successes of the Comprehensive Care for Joint Replacement model. We will use all avenues available to us – including mandatory and voluntary episode-based payment models.”