CMS Delays Implementation of New Radiation Oncology Payment Model

Back in December, the US Congress had passed a bill to delay the implementation of a new radiation oncology model, while also delaying 6-percent Medicare cuts to physician payment that were set to go into effect on January 1. And now, on Wednesday, March 6, the Centers for Medicare & Medicaid Services (CMS), published a proposed rule that would indefinitely delay the implementation of the new radiation oncology bundled payments model that had previously been planned, with no specified date for relaunch.

That move by CMS acknowledges the legislation passed in December that would have required a delay of implementation until January 2023 in any case. In making their announcement on Wednesday, CMS officials acknowledged as much, writing that “The Protecting Medicare and American Farmers from Sequester Cuts Act (PL 117-71) enacted on December 10, 2021 included a provision that prohibits implementation of the Radiation Oncology Model prior to January 1, 2023. Thus, the RO Model did not begin on January 1, 2022. On April 6, 2022, CMS published a proposed rule in the Federal Register, CMS-5527-P2, which proposes to delay the current start date of the RO Model to a date to be determined through future rulemaking. Please reference the proposed rule CMS-5527-P2 here: https://www.federalregister.gov/public-inspection/2022-07525/radiation-oncology-model. The public comment period for the RO Model NPRM (CMS-5527-P2) ends June 7, 2022.”

CMS officials noted that “The Radiation Oncology (RO) Model aims to improve the quality of care for cancer patients receiving radiotherapy (RT) and move toward a simplified and predictable payment system. The RO Model tests whether prospective, site neutral, modality agnostic, Episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD), and freestanding radiation therapy centers for RT episodes of care reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries. The Consolidated Appropriations Act, 2021 (HR 133) enacted on December 27, 2020 includes a provision that prohibits implementation of the RO Model prior to January 1, 2022. CMS has addressed this delay through notice and comment rulemaking in the CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule (CMS-1753-F).”

Further, CMS officials noted that “There is a substantial cost to continue funding preparation for implementation of the [Radiation Oncology] Model in 2023. For example, funding is needed for CMS to prepare for participant onboarding, claims systems changes, and updates to the data used in the model’s design and participant-specific payment amounts, among a number of other activities.” CMS added that devoting funding to the model, which could be delayed again, could take away resources from other payment models. The delay is intended to help model participants which have invested funding to prepare for the model. Given multiple delays and uncertainty about the timing of the [Radiation Oncology] Model indefinitely will give … participants the ability to pause their efforts to prepare for implementation of the [Radiation Oncology] model,” CMS officials said on Wednesday.

The leaders of the American Society for Radiation Oncology (ASTRO) released a statement on Wednesday applauding the delay. It began thus: “The American Society for Radiation Oncology (ASTRO) issued the following statement from ASTRO Board of Directors Chair Laura A. Dawson, MD, FASTRO, in response to the Centers for Medicare and Medicaid Services’ (CMS) decision to delay the start of the Radiation Oncology Alternative Payment Model (RO-APM): “The Centers for Medicare and Medicaid Services today delayed the Radiation Oncology Alternative Payment Model start date from January 1, 2023, to a date to be determined through future rulemaking,” the ASTRO leaders stated: “ASTRO remains hopeful that during this process, CMS also makes the adjustments recommended by Congress and the broad coalition of stakeholders within the radiation oncology community as we remain concerned that the model in its current form is too punitive for clinics. ”

The ASTRO leaders went on to say that “We remain committed to value-based care in radiation oncology. We believe that the modifications proposed by ASTRO and the radiation oncology community will ensure successful participation among physicians and facilities and produce significant savings for the Medicare program. We continue to believe that episodic payments for radiation therapy services have great potential to improve quality and equity while reducing cancer care costs, and we will continue to advocate for proposals that achieve these goals.”

Elements of the planned program had long been controversial in some circles. As Senior Contributing Editor David Raths wrote last September, “The American Society for Radiation Oncology (ASTRO) is urging the Centers for Medicare and Medicaid Services (CMS) to reconsider policy changes related to the 2022 physician fee schedule and the radiation oncology value-based caremodel. ASTRO, which has more than 10,000 members, argues in letters to CMS that the policies will result in $300 million in cuts to cancer care: $140 million in cuts due to several policy changes in the 2022 Medicare Physician Fee Schedule and cuts of $160 million over five years under the mandatory Radiation Oncology Model (RO Model).”

“This double hit will be devastating to our patients and radiation oncology teams, endanger patient access to life-saving treatment and threaten the viability of clinics still reeling from the COVID-19 pandemic,” wrote Thomas J. Eichler, MD, chair of the ASTRO board of directors, in a statement, at that time. “Payment rates for some radiation treatments for breast and prostate cancer will drop by about 13 percent, for example, and by more than 22 percent for advanced lung cancer treatment.”

Further, as Raths wrote, ASTRO officials said back last autumn, that they described themselves as “confused and disappointed” that the proposed policies “stand in such sharp contrast to President Biden’s goals to ‘end cancer as we know it’ and advance health equity . They say the cuts will jeopardize patients’ ability to get state-of-the-art cancer care close to home, with practices treating underserved populations hit hardest by the cuts. Patients in rural areas, risk losing access to cancer treatment in their communities, forcing long and expensive travel to receive care. And this comes at a time when cancer incidence rates are rising due to screening delays related to COVID-19, ASTRO says.”

Further, Raths wrote last fall, “ASTRO recommends that radiation therapy cancer treatments should be held harmless from payment cuts due to the fee schedule’s clinical labor pricing update. “We also are asking that the RO Model’s discount factors be reduced to 3 percent to safeguard access to care for patients at the 950 hospitals and community-based clinics required to participate in the model, while ensuring Medicare achieves a reasonable level of savings,” ASTRO’s Eichler wrote at that time.

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