Congress Delays RO Model to Protect Access to Radiation Oncology Care

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Comparing the Senate and House Covid Stimulus Bills | CPA Practice AdvisorCongress passed legislation on Dec. 22 supported by the American Society for Radiation Oncology (ASTRO) that will delay the start of the Radiation Oncology Advanced Payment Model (RO Model) until Jan. 1, 2022, while bipartisan U.S. representatives sent an oversight letter to Department of Health and Human Services Secretary Alex Azar this week calling for changes to the flawed RO Model. In the letter led by Representatives Brian Higgins (D-N.Y.) and Mike Kelly (R-Penn.), 16 representatives urged the Centers for Medicare and Medicaid Services (CMS) to protect cancer patients’ access to life-saving radiation treatments by scaling back deep reimbursement cuts for the nearly 1,000 radiation oncology providers required to participate in the model.

The Higgins-Kelly letter expressed concern about the steep reimbursement cuts in the RO Model, as well as a lack of clarity on the model that demonstrates the need for further analysis of its impact on practices that are mandated to participate. Starting the RO Model too soon, the letter said, with its extensive administrative and clinical process changes, will be especially taxing on cancer care providers and will reduce access to critical medical services.

"By driving essential reforms in the RO Model, bipartisan Congressional leaders have once again demonstrated impressive support for cancer patients and radiation oncology. ASTRO applauds Congress for responding to the radiation oncology community’s needs by including an RO Model delay in the critical year-end COVID-19 stimulus package," said Thomas J. Eichler, MD, FASTRO, Chair of the ASTRO Board of Directors. "The RO Model is a prime example of a payment model gone awry, focusing more on cutting costs than preserving quality and access. Cloaked in the rhetoric of value-based care, Medicare's model will create significant cost and administrative burden for the nearly 1,000 radiation oncology practices forced to participate. We commend House and Senate leaders, Reps. Higgins and Kelly, Senators Richard Burr (R-N.C.) and Debbie Stabenow (D-Mich.) and the many others that are standing up for access to high quality radiation oncology care."

ASTRO has worked with CMS and bipartisan legislators since 2015 to develop a viable payment model that would stabilize payments, drive adherence to nationally-recognized clinical guidelines and improve patient care. The mandatory RO Model issued by CMS in September, however, would introduce an excessive $230 million in payment cuts and numerous burdensome requirements for practices. In response to ASTRO’s concerns about launching the model during the COVID-19 pandemic, CMS delayed the model start until July 1, 2021, but modified the model’s Advanced APM status, removing the relatively small financial upside for mandated participants.

Led by ASTRO, the radiation oncology stakeholder community has consistently expressed concerns that the CMS model falls short of what is needed to achieve the promise of an alternative payment model for radiation oncology. ASTRO has outlined specific changes to the model that would incentivize high quality care while still generating savings for Medicare. With significant modifications, the RO Model could represent a meaningful approach to enable the field of radiation oncology to participate in the evolving world of health care payment reform. Delaying the model until Jan. 1, 2022 provides time for the new administration to work with the radiation oncology community on reforms to ensure the model’s success.

"ASTRO is committed to working collaboratively on improvements to the RO Model with the incoming Biden Administration, including HHS Secretary nominee Xavier Becerra, who has years of experience ensuring access to high quality cancer care," said Dr. Eichler. "We will continue pursuing a radiation oncology model that will improve quality and reduce costs, albeit not at the extreme level mandated by CMS. For the sake of the medical community and the patients they care for, we will insist on thoughtful, productive approaches to value-based payment."

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Congress Delays RO Model to Protect Access to Radiation Oncology Care.  Appl Rad Oncol. 

By News Release| December 22, 2020
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