Topics
More on Reimbursement

CMS delays start date of radiation oncology payment program after industry criticism

The decision comes after stakeholders said the model could result in even more financial challenges for practices still recovering from COVID-19.

Mallory Hackett, Associate Editor

The Centers for Medicare and Medicaid Services will delay the start date for its Radiation Oncology Model after receiving pushback from industry stakeholders, CMS Administrator Seema Verma said on Twitter.

Verma said the agency plans to push the start date back until July 2021 to give the radiology and oncology community more time to prepare for the changed payment model.

The decision comes after the American Society for Radiation Oncology, or ASTRO, and its members spoke out against the RO Model for fears that it would result in "significant financial challenges" for practices while they are still experiencing revenue declines from COVID-19.

HIMSS20 Digital

Learn on-demand, earn credit, find products and solutions. Get Started >>

"ASTRO is fighting hard to reverse these pending cuts, which are unwarranted and will potentially lead to serious access to care issues across the country," said ASTRO Director of Health Policy Anne Hubbard and Assistant Director of Health Policy Bryan Hull. They wrote in a blog post. "We have engaged ASTRO's congressional champions and have contacted the highest levels of leadership within the Department of Health and Human Services to intervene."

WHAT'S THE IMPACT?

The RO Model, which was originally slated to begin in January 2021, is a mandatory value-based payment model.

It requires participation from radiotherapy providers and suppliers within randomly selected core-based statistical areas. It provides bundled payments for a 90-day episode of care and covers 16 cancer types. In total, about 30% of radiotherapy episodes are included in the model.

The updated payment structure is participant-specific based on proposed national base rates, trend factors and adjustments for each participant's case-mix, historical experience and geographic location. It also includes a discount factor of 3.75% for the professional component payment and 4.75% for the technical component payment.

CMS said it wanted to test whether this value-based prospective, site-neutral, modality agnostic, episode-based payment model incentivized physicians to deliver higher-value radiotherapy care than the current fee-for-service model. The model has a five-year performance period to prove its effectiveness.

ASTRO takes issue with the trend-factor aspect of the payment structure because it takes into consideration Medicare physician fee schedule rates and the hospital outpatient prospective payment system, which the organization says will put an additional financial strain on practices.

That, plus the discount factors of 3.75% and 4.75% payment withholds for quality measures performance and incorrect payments could result in a low or even negative trend factor, leading to fluctuating rates, according to ASTRO.

Instead of making the RO Model mandatory, ASTRO suggested in a statement that CMS launch the model as voluntary, then transition to a mandatory model that includes opt-outs for low-volume practices and hardship exemptions.

THE LARGER TREND

CMS has been pushing for more value-based payment models as a part of its larger quality strategy to reform how healthcare is delivered and paid for.

It already has programs in place for end-stage renal disease, hospital readmissions, skilled nursing, home health and more.

The agency has been working on putting a value-based program for radiation oncology in place since 2014. Radiotherapy is ready for payment and service delivery reform because of the lack of site neutrality for payments, incentives that encourage volume of services over the value of services, and coding and payment challenges, according to a report from the Department of Health and Human Services to Congress.

Although stakeholders objected to this value-based program, most are on board with the industry's shift. Now, the biggest issue for health leaders is figuring out how to implement them, not whether they should be implemented.

Twitter: @HackettMallory
Email the writer: mhackett@himss.org