Radiation Oncology Alternative Payment Model

Congress has acted in a bipartisan manner numerous times to protect patient access to radiation therapy. In 2015, Congress passed legislation requiring that Medicare maintain payment rates while CMS worked with the radiation oncology community to develop an alternative payment model (APM) to ensure access to RO services. Congress acted in 2018 to extend the payment freeze to provide additional time for the development of the APM, including continued engagement with stakeholders.

After release of the CMS proposed RO Model in 2019, bipartisan Senators and Representatives wrote CMS to express concern that the model did not balance the incentive to participate with decreases in payment rates. Congress asked CMS to address the scope, implementation, and payment structure of the model, including allowing more time for practices to implement the model and reductions in the proposed discount factor payment reductions. Congressional concerns were largely ignored in the final RO Model. Congress stepped in again with the passage of the COVID-19 Emergency Relief Package that effectively delays the implementation of the RO Model until January 1, 2021. This delay provides ample opportunity to make fundamental changes to the RO Model so that it functions as a viable and meaningful values-based payment opportunity for radiation oncology.

ASTRO continues to urge Congress and CMS to act to reduce the discount factor cuts to 3% or less, a level consistent with MACRA’s intent and other payment models.