CMS Postpones Radiation Oncology Model Until July

December 12, 2020
Gianna Melillo

Gianna is an associate editor of The American Journal of Managed Care® (AJMC®). She has been working on AJMC® since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey.

In its 2021 Hospital Outpatient Prospective Payment Final Rule, CMS announced it will delay its radiation oncology payment model from January 2020 until July 2021.

In its 2021 Hospital Outpatient Prospective Payment Final Rule, CMS announced it will delay its radiation oncology payment model from January 2020 until July 2021. The move ensures participation in the Radiation Oncology Model (RO Model) during the public health emergency of the coronavirus disease 2019 (COVID-19) pandemic does not further strain RO participants’ capacity, according to CMS. The performance period will end on December 31, 2025.

The decision was made after CMS said it received feedback from stakeholders concerned about the challenges of preparing to implement the new RO payment model by January, including revenue losses for RO participants due to decreased patient volumes and layoffs or staff reallocations due to COVID-19.

“The payment model will test prospective, bundled payments to providers for 16 cancer types, aiming to improve care outcomes for radiotherapy patients while lowering Medicare costs,” Becker’s Hospital Review reports. “Under the model, payments would cover 90-day episodes of care.”

The RO Model is a step forward in CMS’ incorporation of new models for value-based cancer care. However, a 2018 study investigating whether accountable care models had an effect on cancer care spending found an $11 difference per beneficiary, indicating that models created for primary care may not be applicable for oncology purposes.

The study, presented by Miranda Lam, MD, at the Institute for Value-Based Medicine®, analyzed Medicare accountable care organizations (ACOs) for patients with cancer. Lam examined national Medicare claims from 2011 to 2015; practices that became part of ACOs were identified and matched to non-ACO practices within the same region. She and her coauthors looked at whether the introduction of ACOs led to lower overall spending, lower spending by service type, and spending on cancer-specific services (radiation therapy, chemotherapy, hospitalizations, emergency department use, and hospice).

A difference-in-difference analysis showed that the introduction of ACOs had no meaningful impact on overall spending (–$308 per beneficiary in ACOs vs –$319 in non-ACOs; difference, $11; 95% CI, –$275 to $297; P = .94).

Within the 11 different cancer types examined, there was no change in total spending. And changes in spending and utilization did not meaningfully differ between ACO and non-ACO patients within cancer-specific categories.

But unlike the ACOs studied, participation in in the 2-sided risk RO Model will be mandatory, the payments will be site neutral between freestanding and hospital outpatient departments, and payments will be prospective rather than retrospective.