Radiation Oncologists Take to Capitol Hill to Emphasize Importance of Specialty APM

As radiation oncologists met with policy makers in Congress as part of the 15th annual American Society of Radiation Oncology Advocacy Day, the need for a radiation oncology–specific alternative payment model (APM) was one of the key topics of discussion.

Radiation oncologists met with policy makers in Congress on June 26 to discuss a range of policies that will protect access to high-quality, high-value care for patients with cancer, including the use of alternative payment models (APMs).

As part of the American Society of Radiation Oncology (ASTRO) Advocacy Day, radiation oncologists emphasized why they need to participate in APMs and how doing so preserves patient access to quality care; the importance of supporting research with continuous and stable funding; the need to avoid health insurance coverage disruptions for patients with cancer; and protecting medical access to radioactive material.

“More than 1 million cancer patients are treated with radiation therapies each year, either to cure their cancer or relieve pain and other difficult symptoms. Radiation oncology provides immense value to the health care system,” Brian Kavanagh, MD, MPH, FASTRO, chair of the ASTRO Board of Directors, said in a statement. “Radiation oncologists are visiting Capitol Hill to remind Congress of the multidisciplinary nature of cancer care and call for the opportunity to participate meaningfully in the nationwide transition to value-based healthcare.”

ASTRO has been working with the Center for Medicare and Medicaid Innovation to develop and launch a Radiation Oncology Alternative Payment Model (RO-APM). ASTRO proposed this APM in 2017 in response to the Medicare Access and CHIP Reauthorization Act, which accelerates the shift from volume to value and includes participation in APMs as a track for Medicare reimbursement.

RO-APM incentivizes adherence to clinical guidelines for breast, prostate, lung, colorectal, and head and neck cancers. The model also seeks to achieve 3 primary goals:

  1. Rewarding radiation oncologists for participation and performance in quality initiatives
  2. Ensuring fair, predictable payment for radiation oncologists in both the hospital and community cancer clinics
  3. Incentivizing the appropriate use of cancer treatments that result in the highest quality of care and best patient outcomes.

During the visit to Capitol Hill, the radiation oncologists also voiced their support for recent legislation that locked reimbursement rates for key radiation therapy services at 2016 levels through the end of 2019. In the years before, Medicare reimbursement rates for radiation oncology sustained significant cuts between 2009 and 2014. The reimbursement rate freeze provides additional time for ASTRO and CMS to finalize development of a successful RO-APM—when ASTRO first proposed the APM, it had hoped to have it in place in time for participation beginning January 1, 2018.

“With the support of key Congressional leaders, we currently have much-needed stability in radiation oncology payments,” Kavanagh said. “Congress must prevent any additional payment cuts to radiation therapy centers to avoid jeopardizing access to critical, life-saving services and compromising our progress toward value-based care.”