In the fall of 2015, ASTRO organized a comprehensive response to Medicare payment threats that included obtaining support for radiation oncology against Medicare payment cuts from 207 members of Congress representing both chambers and both major parties. Led by Sens. Richard Burr (R-N.C.) and Debbie Stabenow (D-Mich.), and Reps. Devin Nunes (R-Calif.) and Paul Tonko (D-N.Y.), the support letters called particular attention to the burden that community-based clinics would face by losing the payment stability that is essential to ensure accessible, affordable care for their patients.

Thanks in part to radiation oncology's Congressional champions, reimbursement reductions in the final 2016 Medicare Physician Fee Schedule (MPFS) were less severe than originally proposed. Moreover, the Patient Access and Medicare Protection Act (S. 2425) passed in December, freezing payment rates for freestanding radiation oncology centers through 2018 at the levels set under the 2016 MPFS and bringing these centers one step closer to payment stability.


Medicare payment stability allows radiation oncology to transition away from the antiquated "fee-for-service" model toward the promise of alternative payment models (APMs) authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). APMs incentivize physician participation in performance-based payment models and move the reimbursement structure from a system of volume to one of value. ASTRO members emphasized the potential for specialty medical societies to help lawmakers incorporate robust quality improvement programs into APMs and the Merit-based Incentive Program (MIPS) under MACRA.

"ASTRO's advocacy efforts since 2009 have prevented more than $500 million in proposed Medicare payment cuts to radiation oncology, and we've helped pass legislation that brings some much-needed payment stability to doctors across the discipline through 2018" said ASTRO Chair Bruce D. Minsky, MD, FASTRO. "In addition to fighting for fair and stable reimbursement, ASTRO is leading the way to develop alternative payment models for radiation oncology that will support the delivery of high value, high quality care for our patients."

ASTRO also encouraged Congress to protect patients by helping ensure treatment decisions are based on clinical judgment rather than financial gain, through narrowing exceptions in the Ethics in Patient Referrals Act that allow for physician self-referral abuse. Multiple studies, such as 2013 reports published by the Government Accountability Office (GAO) and in the New England Journal of Medicine, have shown that physician self-referral leads to increased utilization of services that may not be medically necessary and poses a potential risk of harm to patients. The Promoting Integrity in Medicare Act of 2016 (HR 5088) introduced by Reps. Jackie Speier (D-Calif.) and Jim McDermott (D-Wash.) would close the loophole in current policy that allows for self-referral abuse, help drive payment and delivery system reform and save an estimated $3.3 billion dollars in unnecessary Medicare spending over the next decade.

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