ASTRO Hopes CMS Indefinite Delay to RO Model Leads to Value-Based Reimbursement

Following the final rule from the Centers or Medicare and Medicaid Services' (CMS) that indefinitely delays the start of an alternative payment model for radiation oncology (the RO Model), the American Society for Radiation Oncology (ASTRO) issued the following statement from ASTRO Board of Directors Chair Laura A. Dawson, MD, FASTRO.

“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.”

In June, ASTRO submitted comments to CMS that summarized longstanding concerns from the radiation oncology community and bipartisan members of Congress about the model’s emphasis on cost savings over treatment quality. CMS estimated that the RO Model would create $150 million in cuts to radiation oncology, compounding the inflation- and utilization-adjusted 27% drop in Medicare reimbursement for radiation therapy services incurred over the past decade. The letter also outlined reforms to the RO Model that would foster successful participation from physicians and generate substantial saving for the Medicare program.

ASTRO currently is developing a new proposal for an alternative payment model to share with stakeholders later this year. In addition to an emphasis on episodic payments, the new proposal will emphasize ways to help patients from economically and socially marginalized groups access and complete radiation treatments.