
CMS Proposes Bundled Payments for Radiation Oncology
CMS has proposed the mandatory Radiation Oncology Model, which would cover radiation therapy spanning a 90-day episode.
As the Trump administration announced 5 new payment models to transform kidney disease care yesterday, CMS also proposed implementing bundled payments for radiation oncology. The agency announced the proposed Radiation Oncology (RO) Model, which could come as soon as January 1, 2020, and would cover 17 different types of cancer.
Both the RO Model and the
Under the RO Model, CMS would make bundled payments to physician group practices, hospital outpatient departments, and freestanding radiation centers that would cover radiation therapy spanning a 90-day episode. The model would be mandatory in certain parts of the country in order to determine whether prospective site-neutral, episode-based payments could reduce Medicare costs while improving the quality of care. In the proposed rule,
The model would qualify as an Advanced Alternative Payment Model (APM) and a Merit-based Incentive Payment System APM and would have a performance period of 5 years, beginning either January 1 or April 1, 2020, and ending December 31, 2024. HHS Secretary Alex Azar
CMS cited 3 reasons for the need for payment reform in radiation oncology: lack of site neutrality for payments, incentives that encourage volume over value, and coding and payment challenges.
The payments would be split into 2 parts: a professional component to cover services that may be provided only by a physician, and a technical component to cover services not provided by a physician, including the provision of equipment, supplies, personnel, and costs related to radiotherapy services.
The 17 cancer types that would be incorporated in the model are all commonly treated with radiation, make up the majority of cancer incidence, and have demonstrated pricing stability. These include anal cancer, bladder cancer, breast cancer, cervical cancer, colorectal cancer, head and neck cancer, lung cancer, pancreatic cancer, and prostate cancer.
Following the announcement, organizations responded with praise for a value-based model in radiation oncology but caution over the model being mandatory. Paul Harari, MD, FASTRO, chair of the American Society for Radiation Oncology (ASTRO),
He added that ASTRO will submit comments on the specifics of the model, including the requirements for certain radiation oncology groups to participate.
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