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Gus Iversen, Editor in Chief | July 19, 2024
The Radiation Oncology Case Rate (ROCR), part of a bipartisan bill introduced in May, aims to maintain access to cancer treatments while reducing disparities and improving patient outcomes — but can it deliver the goods?
A study by Mayo Clinic and the Harvey L. Neiman Health Policy Institute set out to explore the potential effects of the ROCR reimbursement, and found it could yield up to 3% savings in Medicare spending across 15 cancer types compared to the traditional fee-for-service model.
The study validated ROCR model findings using several years of EHR data from Mayo Clinic and a 5% sample of national Medicare fee-for-service claims.
The ROCR model emerged after CMS faced challenges implementing the Radiation Oncology Alternative Payment Model (RO-APM), with concerns about inadequate reimbursement under RO-APM threatening the financial stability of radiation oncology practices and patient access to care. The American Society for Radiation Oncology (ASTRO)
has expressed strong support for the initiative.
“The ROCR model addresses congressional goals by prioritizing value over volume and reducing Medicare expenditures while mitigating fears that episode-based payments could undermine the financial health of radiation oncology practices,” said Dr. Aaron Bush of Mayo Clinic Florida.
A notable aspect of the ROCR Act is the Health Equity and Achievement in Radiation Therapy (HEART) initiative. This initiative seeks to address transportation challenges that disproportionately affect rural and underserved patients, enhancing their access to potentially lifesaving radiation therapy. The initiative is inspired by successful outcomes from a National Cancer Institute-funded study that demonstrated improvements in treatment completion and survival rates through targeted support.
Furthermore, the ROCR Act aims to rectify more than a decade of cuts to Medicare payments for radiation therapy, which have been reduced by 23% over the past ten years. By reforming payment structures and reducing administrative burdens, the act strives to provide a more stable and equitable funding environment for radiation oncology services.
Elizabeth Rula, Ph.D., executive director of the Harvey L. Neiman Health Policy Institute, highlighted advancements in radiation oncology favoring shorter treatment courses. “Episode-based payments align economic incentives with evidence-based practices, promoting the adoption of new, abbreviated treatment regimens that benefit patients,” she explained.
The study was published online by the International Journal of Radiation Oncology, Biology, Physics. Economic research for ROCR was funded by a grant from the Harvey L. Neiman Health Policy Institute, which also provided the Medicare data analysis.
