Medicare Payments

ASTRO applauds Congressional repeal of the Sustainable Growth Rate (SGR) and the development a new value-based Medicare physician payment system in the Medicare Access and CHIP Reauthorization Act (MACRA). For several years, ASTRO has been working with stakeholders to develop a Radiation Oncology Alternative Payment Model (APM) that is consistent with the goals of MACRA. The model involves episodes of care for radiation oncology and applies quality measures to four distinct disease sites — breast, prostate, lung and colorectal cancers — and features shared savings to the Medicare program and participating physicians. It is critical that radiation oncologists have the opportunity to participate in an APM to realize the goals of MACRA, yet ASTRO is concerned that:

  • The Oncology Care Model (OCM), currently the only oncology-focused model in the Advanced APM portfolio, discourages multidisciplinary care by giving participating practices the unintended incentive to reduce utilization of appropriate therapies due to their relative cost in a six-month period.
  • An overly narrow approach will crowd out many disease, condition, or episode-specific models that could potentially broaden the Advanced APM portfolio.
  • This restrictive interpretation will have a chilling effect on specialty-specific collaborations with payers on models that result in reduced cost and improved outcomes.

Additionally, radiation oncology reimbursement rates have sustained significant cuts in recent years resulting in cumulative payment reductions totaling approximately 20 percent for freestanding cancer centers. While passage of the Patient Access and Medicare Protection Act (PAMPA) has temporarily created a more stable environment to work with the Centers for Medicare and Medicaid Services on radiation treatment delivery coding and valuation issues and alternative payment models, it is important to prevent any additional payment cuts to community-based radiation therapy centers and preserve access to these critical services.