In response to a request from bipartisan members of Congress, ASTRO issued a letter seeking “major reforms” to Medicare physician payments that best serves the needs for beneficiaries, physicians and taxpayers. The letter notes that radiation oncology has had a front row seat to witness the serious flaws in the physician fee schedule and the difficulties in transitioning to value-based payments. ASTRO also echoed principals for physician payment reform developed in partnership with the American Medical Association and other physician groups seeking financial stability and predictability, promoting value-based care, and safeguarding access to high-quality care. The request for ideas is among the first steps Congress is taking to address a series of Medicare physician pay cuts by year-end and to consider longer-term reform legislation next year.