The Biden administration has finalized a rule that indefinitely delays the controversial radiation oncology payment model, which generated significant pushback from providers. The Centers for Medicare & Medicaid Services (CMS) issued a final rule surrounding the payment model that intended to reimburse oncology practices and outpatient sites for a total episode of care. It would also develop site-neutral payments for certain radiation therapies. CMS was dismayed that Congress has delayed the start date for the payment model twice, with the latest to January 1, 2023. However, there remained uncertainty over whether lawmakers would again pass a delay. CMS was concerned about still devoting resources to keep the model going.
More on Model, Delay, and Reaction
The alternative payment and care delivery model for cancer care aims to improve quality of care for patients who receive radiotherapy and establish a predictive payment system for providers who deliver those services. The model would do that through site-neutral bundled payments for a 90-day episode of radiotherapy and related services. Providers in randomly selected areas would be required to participate, according to program rules. However, cancer care providers have questioned the model’s methodology, particularly its mandatory nature, since CMS announced it in 2019.
CMS said in the final rule that it continues to believe that the Radiation Oncology 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.”
However, CMS decided to postpone the launch date given the legislative delays and persistent criticisms from industry stakeholders who have called for change. The agency also announced in the final rule that it would redefine the performance periods. Moving forward, CMS plans to propose a new start date “no less than 6 months prior to that proposed start date.”
The American Society for Radiation Oncology (ASTRO) said in a statement given by Board of Directors Chair Laura A. Dawson, MD, FASTRO, that this indefinite delay of the Radiation Oncology Model “provides an opportunity for CMS to work with stakeholders on a new value-based reimbursement structure for radiation therapy.”
“The Centers for Medicare and Medicaid Services (CMS) today finalized an indefinite delay for the Radiation Oncology Model. 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.
Fair and stable Medicare payments are essential to support modern cancer care, especially as clinics face rising inflation costs. We are optimistic that CMS will work more closely with the radiation oncology community on a reformed push for episodic payments.”