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CMS indefinitely delays start of radiation oncology model

by John R. Fischer, Senior Reporter | September 01, 2022
Insurance Rad Oncology
CMS has indefinitely delayed the start of radiation oncology model.
The Centers for Medicare & Medicaid Services has indefinitely delayed the start date for the controversial radiation oncology payment model.

The agency issued a final rule on August 25 to push back the date due to legislative delays, criticism from providers and other industry stakeholders, and concerns about continuing to devote resources to the model, according to RevCycleIntelligence.

“There is a substantial cost to continue funding preparation for implementation. For example, funding is needed for CMS to prepare for participant onboarding, claims systems changes and updates to the data used in the model’s design,” it said in the final rule.

Introduced in 2020, the alternative payment model would replace the current fee-per-service system with one that facilitates reimbursement through site-neutral bundled payments for a 90-day episode of radiotherapy and related services, creating a simpler, more predictable payment system and improving quality of care for radiotherapy patients. Providers in randomly selected areas would be required to participate.

CMS estimated that the RO model would cut $150 million from radiation oncology, compounding the inflation- and utilization-adjusted 27% drop in Medicare reimbursement for radiation therapy services experienced over the last 10 years.

Many providers criticized the model for this, compelling Congress to push back its launch date from January 2021 to July of that year. It again delayed the model due to COVID-19, to January 1, 2023.

CMS
proposed indefinitely delaying the model back in April.

While it believes the RO model “would address long-standing concerns related to RT delivery and payment, including the lack of site-neutrality for payments, incentives that encourage volume of services over the value of services, and coding and payment challenges,” it says continuing to invest in it would take away resources needed for developing other alternative payment models, reported RevCycleIntelligence.

Provider groups applauded the decision. “ASTRO continues to believe that episodic payments will improve access and quality, advance health equity and reduce costs in cancer care. We hope that this official delay provides an opportunity for CMS to work with stakeholders on a new value-based reimbursement structure for radiation therapy,” said Dr. Laura Dawson, FASTRO, board of directors chair for the American Society for Radiation Oncology, in a statement.

ASTRO is developing a proposal for an alternative payment model to help economically and otherwise marginalized patients get access to complete radiation treatments.

It also has ideas for reforming the RO model in a way in which physicians can participate, while gaining substantial savings for Medicare.

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