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ASTRO, Congress Urge CMS to Adjust Radiation Oncology APM

November 14, 2019

Congressional leaders from both political parties issued a series of oversight letters to the Centers for Medicare and Medicaid Services (CMS) in recent months that implored the agency to amend its proposed radiation oncology advanced alternative payment model (RO Model).

CMS is expected to issue its final plan before the end of 2019 and begin the model on January 1, 2020.

Numerous republican and democrat representatives wrote to CMS administrator Seema Verma to ask for revision of the RO Model prior to finalization in order to protect cancer patients’ access to life-saving radiation therapy. Representatives focused their efforts on the scope, implementation, and payment structure of the proposed model.

Specifically, representatives have identified the mandate that requires a high percentage of radiation oncology practices to participate as a key area of concern. Additionally, they list the planned start date as well as the proposed bundled payment rates not accounting for community-based clinic costs and curative treatments as further areas of concern.

The letters highlight the misalignment between substantial “discount factor” payment cuts for participants without adequate incentive payments provided under existing Medicare law.

Representative Brian Higgins (Democrat – NY) wrote, “I ask that CMS consider making the model voluntary or allow for a phased-in approach to allow for any issues to be addressed before requiring such a large contingent of radiation oncology providers to participate.” He also stated his concern that “the reductions in payments that would result from the proposed methodology would be too severe for many radiation oncology practices to be required to bear.”

The American Society for Radiation Oncology (ASTRO) expressed gratitude to the representatives who voiced concern about the model (November 13, 2019). ASTRO believes that an improved RO model will allow over 4500 radiation oncologists to begin transitioning to value-based care and incentivize higher quality radiation treatments for patients. On September 16, 2019, ASTRO submitted official comments to CMS that expressed concerns of the proposal falling short of what is needed to achieve the promise of an alternative payment model for radiation oncology.

Zachary Bessette

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