"Medicare is not meeting its obligation to maintain fair and stable payments," said Laura Dawson, MD, FASTRO, Chair of the ASTRO Board of Directors. "These excessive reductions jeopardize access to life-saving radiation therapy services for Medicare beneficiaries at a time when clinics are recovering from the COVID-19 pandemic and treating patients with more advanced cancers."
In April 2022, the Centers for Medicare and Medicaid Services (CMS) announced an indefinite delay to the radiation oncology alternative payment model (RO Model). The model's excessive payment cuts and administrative burden have drawn significant criticism from the radiation oncology community and bipartisan members of Congress. ASTRO remains committed to value-based payment for radiation oncology, however, and is developing a new proposal for an alternative payment model to share with stakeholders later this year. The new proposal will emphasize ways to help patients from economically and socially marginalized groups access and complete radiation treatments.
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"We continue to believe that episodic payments for radiation therapy services have great potential to improve access and quality, advance health equity and reduce cancer care costs, and we will continue to advocate for proposals that achieve these goals," said Dr. Dawson.
ASTRO Ask #2: Restrict excessive prior authorization practices that delay patient care and waste health care resources (view press kit)
Prior authorization is consistently ranked by radiation oncologists as the biggest challenge facing their clinics, and radiation oncology faces the most prior authorization hurdles of any medical specialty, causing unnecessary anxiety, delays and harm for people already dealing with the burden of cancer.
Nine in 10 radiation oncology practice leaders say their patients are delayed from cancer treatment due to prior authorization, and a majority say the average delay lasts a week or longer. Research has linked each week of delay in starting cancer therapy with a 1.2% to 3.2% increased risk of cancer death. Seven in 10 radiation oncologists say their patients regularly express concerns about their treatment delays due to prior authorization.
While radiation oncologists face a disproportionately high number of prior authorization obstacles, these problems stretch across the American health care system. An April 2022 report from the inspector general's office of the Health and Human Services Department concluded that 13% of Medicare Advantage prior authorization requests, or about 85,000 beneficiaries, were improperly denied in 2019.
