Congressional leaders support radiation oncology community concerns about proposed Medicare alternative payment model

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Congressional leaders support radiation oncology community concerns about proposed Medicare alternative payment model

Press releases may be edited for formatting or style | November 13, 2019 Rad Oncology

Representative Higgins (D-N.Y.)
Rep. Higgins also challenged the requirement that approximately 40% of practices participate in the model. “I ask that CMS consider making the model voluntary or allow for a phased-in approach to allow for any issues to be addressed before requiring such a large contingent of RO [radiation oncology] providers to participate.” He also asked that “the magnitude and type of discounts, withholds, and adjustments to the model’s payment calculation be reevaluated, as I am concerned that the reductions in payments that would result from the proposed methodology would be too severe for many RO practices to be required to bear.” Read the letter from Rep. Higgins.

Representative Holding (R-N.C.)

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Rep. Holding questioned CMS on the direct payment cuts, or “discount factors,” proposed to technical and professional payments. “A strong radiation oncology APM [alternative payment model] should employ a payment structure that balances incentives to providers with ensuring beneficiary access to the full array of radiation modalities. I encourage CMS to consider reductions to the professional and technical discount factors,” he wrote. Read the letter from Rep. Holding.

Representative Simpson (R-Idaho)
Rep. Simpson addressed concerns with the proposed model’s mandatory participation and payment methodology. He also emphasized the contributions that radiation oncology innovation has made for patients with cancer, noting that the RO Model might chill investments in new technology and service lines that provide clinical benefit to patients. “I recommend that CMS make these essential reforms and others suggested by the radiation oncology community to better strike the appropriate balance between savings, access and quality. This includes ensuring that the model does not put financial or administrative burden on practices that are willing to take on risk under the model,” he wrote. Read the letter from Rep. Simpson.

Representative Tonko (D-N.Y.)
Rep. Tonko expressed concern that some aspects of the proposed RO Model will “undermine the goals of payment reform.” He listed several specific issues CMS must address and added that “if CMS’s proposed rule is finalized, radiation therapy services would face several unintended consequences that would jeopardize access to care.” Read the letter from Rep. Tonko.

"ASTRO thanks the many Senators and Representatives who wrote and called CMS with concerns about the model," said Theodore L. DeWeese, MD, FASTRO, Chair of the ASTRO Board of Directors. "The radiation oncology community appreciates Congress’ strong interest in reforming the RO Model and is committed to working with policymakers to improve it for the benefit of cancer patients."

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