ASTRO says CMS alternative payment model for radiation oncology 'falls short'

por John R. Fischer, Senior Reporter | September 18, 2019
Rad Oncology
ASTRO recommends CMS implement a number
of changes in its proposed RO model
Amidst the research presentations and showcases of cutting edge oncology care technology, the American Society of Radiation Oncology took time this week during its annual meeting to express its thoughts on the advanced alternative payment model proposed by the Centers for Medicare and Medicaid Services for radiation oncology.

First issued in July of this year, the proposal aims to further integrate value-based care in cancer treatment by encouraging the adoption of prospective site-neutral, episode-based payments. CMS claims that its model would reduce Medicare expenditures, while maintaining or enhancing the quality of care for Medicare beneficiaries. It is currently accepting commentary for potential adjustments that can be made to it.

“ASTRO appreciates CMS’ decision to move forward with an alternative payment model for radiation oncology and believes there are some positive elements in the proposed Radiation Oncology Model (RO Model),” said Paul Harari, M.D., FASTRO, chair of the ASTRO board of directors, in a statement. “We are concerned, however, that the proposal by the agency falls short of meeting three key goals established by ASTRO for the successful development of an alternative payment model.”

The goals in question include rewarding radiation oncologists for participation and performance in quality initiatives that improve the value of healthcare for patients; ensuring fairer, predictable payment for radiation oncologists in both hospital and freestanding cancer clinics to ensure patients in any setting have access to quality care; and incentivizing appropriate use of cancer treatments that result in the highest quality of care and best patient outcomes.

Based on its estimates, ASTRO claims that the model, if enacted, would cut payments to required participants by approximately $320 million during the first five years of its use, and recommends that CMS consider implementing specific changes to promote high-quality and efficient radiotherapy treatments that ensure value-based reform is met, and provide savings for Medicare.

Among its recommended changes are:

• Mandatory Participation: ASTRO claims requiring participation representing 40 percent of radiation oncology episodes is too much for an untested model. It suggests the model first be voluntary, and over time become mandatory on a limited basis, with opt-outs for low-volume practices and hardship exceptions.

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