CMS delays start date for radiation oncology payment model

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CMS delays start date for radiation oncology payment model

by John R. Fischer, Senior Reporter | October 22, 2020
Rad Oncology
CMS has pushed back the start date of the new radiation oncology payment model from January 1 to July 1, 2021
The Centers for Medicare & Medicaid Services (CMS) has pushed back the start date for the new radiation oncology model, as recommended by providers and healthcare stakeholders in the radiotherapy community.

Initially scheduled to begin January 1, the new model will now go into effect on July 1, 2021. “The @CMSGov team and I have listened to the feedback from @ASTRO_org and the radiation oncology community regarding the start date of the new Radiation Oncology (#radonc) Model, and understand that more time is needed to prepare,” CMS administrator Seema Verma tweeted Wednesday.

The model is a replacement for the current fee-per-service payment system and facilitates compensation through bundled payments across a 90-day episode of care for 16 different cancers. It is expected to reduce Medicare expenditures and save it $230 million over five years, while ensuring simpler, more predictable payments. Participation will be required among radiotherapy providers and suppliers that offer their services within randomly selected geographic areas with approximately 30% of all eligible Medicare fee-for-service radiotherapy episodes nationally.

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The initial start date of the model was announced in September and met with criticism. The American Society for Radiation Oncology (ASTRO) called January 1 an “untenable” starting date due to staff shortages and other challenges endured as a result of the COVID-19 pandemic and because of the practice changes and investments providers would have to make in such a short period of time.

"ASTRO appreciates today’s announcement by CMS administrator Seema Verma that CMS will delay the Radiation Oncology Model launch from January 1, 2021, until July 1, 2021 based on feedback from ASTRO and other radiation oncology stakeholders,” said the society in a statement. “This change is an important recognition of the radiation oncology community’s concerns, and we are pleased and thankful that administrator Verma listened to the needs of our member radiation oncology practices during these challenging times.”

ACR also expressed concern earlier this month in a letter to Verma. “The ACR is alarmed that such a significant number of small and rural practices are included in the model, while many large metropolitan areas have been spared, and are expected to use their limited resources to adopt and implement certified EHR technology, among all of the other reporting requirements for participation,” ACR chief William Thorwarth Jr. wrote October 2.

The current payment systems for different types of providers offer different rates, which can incentivize Medicare providers and suppliers to provide radiotherapy over more visits or deliver it in one setting over another. This can create extra costs for patients, even though the actual treatment and care is the same.

The new model is expected to make the value of services the incentive for payments over volume, which according to CMS is not always what is clinically appropriate for beneficiaries. It is meant to create a system of participant-specific payment amounts, determined based on national base rates, trend factors, and adjustments for each participant’s case mix, historical experience, and geographic location.

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