New national survey data from the American Society for Radiation Oncology (ASTRO) show that further cuts to Medicare reimbursement for radiation therapy would increase patient wait times for cancer treatment and force clinic downsizing. Nearly all (96%) of the 675 physicians responding to the survey say that patient access will suffer under another cut, and seven in 10 say the impact will be significant.

Radiation oncologists from across the country are on Capitol Hill today urging lawmakers to pass the bipartisan Radiation Oncology Case Rate (ROCR) Act before additional Medicare cuts are proposed. ROCR would stabilize Medicare payments, protect patient access and enhance cancer treatment outcomes by shifting from an outdated volume-based system to a value-based, bundled-payment model.

“More than a million Americans rely on radiation therapy each year, but relentless Medicare reimbursement cuts, harmful prior authorization delays and insufficient cancer research funding are threatening patients’ access to this lifesaving care," said ASTRO Board of Directors Chair Howard M. Sandler, MD, FASTRO. “We’re asking Congress to help safeguard access to affordable, high-quality care for people with cancer by passing legislative solutions including the ROCR Act this year.”

ASTRO’s new survey highlights several ways that further Medicare cuts will hurt patients and clinics:

• One third of the doctors in rural areas (32%) and 38% at independent, freestanding centers said another 3-5% cut would force them to close, consolidate, leave or sell their practice.

• Many doctors said another cut will lead to practice downsizing such as reducing staff (65% of respondents) and make it more difficult to hire and retain staff (86%). Nine in ten (87%) also said another cut would delay or deter upgrades and investments in treatment technologies.

• Two-thirds of the doctors (65%) said more cuts will lead to patients waiting longer for their cancer treatments. Doctors at academic centers and in urban areas, especially, anticipate longer wait times. (Additional findings at the end of this release.)

Reimbursement for radiation therapy under Medicare has fallen 25% since 2013, more than most other medical specialties. Ongoing cuts are compounded by rising costs and declining utilization as the field moves toward shorter treatments for many cancers. Increasing financial pressures from these factors, in turn, drive rampant practice consolidation, reducing competition and force many patients to travel farther for cancer care.

The bipartisan ROCR Act (S.1031, HR.2120), led by Senators Thom Tillis (R-N.C.) and Gary Peters (D-Mich.) and Representatives Brian Fitzpatrick (R-Pa.), Jimmy Panetta (D-Calif.), John Joyce, MD (R-Pa.), Paul Tonko (D-N.Y.), Scott Peters (D-Calif.) and Haley Stevens (D-Mich.), would address these challenges by centering reimbursement around each patient’s individualized treatment plan rather than the number of treatments given.

ROCR would:

• Protect Americans’ access to high quality cancer care while generating Medicare savings.

• Align payment incentives with clinical guidelines to reward evidence-based care.

• Support shorter treatments for certain cancers, giving patients more days at home.

• Overcome transportation barriers that keep many patients from finishing treatment.

“Clinical guidelines increasingly favor shorter treatments that improve patients’ quality of life, but the current reimbursement system inadvertently penalizes these advances,” said Dr. Sandler. “Technology and guidelines evolve, yet Medicare’s payment structure remains the same. By passing ROCR, Congress would modernize reimbursement and align payment with best practices in cancer treatment.”

ROCR is broadly supported by nearly 110 organizations representing a broad spectrum of oncology stakeholders including patient advocates, medical professionals, small and large hospital systems, academic centers, independent clinics and industry. Read more about ROCR and ASTRO’s work toward payment stability for radiation oncology.

Prior Authorization

Radiation oncologists also are asking Congress to support bipartisan legislation expected this week that would bring much-needed reform to Medicare Advantage’s broken prior authorization system. Despite promising rulemaking by the Centers for Medicare & Medicaid Services (CMS), ASTRO members consistently report that struggles with benefits management companies are causing unnecessary delays and other problems for their patients.

In a fall 2024 ASTRO survey of 750 radiation oncologists nationwide, 92% said prior authorization delays their patients from starting cancer treatment, and 68% said these delays last a week or longer. One-third said prior authorization has led to adverse events such as hospitalization for their patients, and 85% say the burden has increased in recent years.

Research indicates that Medicare Advantage’s prior authorization requirements for radiation therapy are failing to produce savings, and that these plans are associated with higher overall costs than traditional Medicare plans. ASTRO surveys also find that most denials are ultimately in vain, with two-thirds of doctors reporting that most of their denials are overturned. Read more about ASTRO’s efforts for prior authorization reform.

Cancer Research Funding

Bipartisan federal support for cancer research has contributed to a 34% reduction in cancer mortality, averting nearly four million deaths from cancer in the U.S. over the past three decades. Federal funding drives the discovery of new technologies and treatments, including radiation therapy breakthroughs, that increase patients’ survival chances and improve their quality of life, but this progress relies on sustained investment that grows with inflation.

Investments in cancer research also produce outsized economic benefit; in FY24, the National Institutes of Health (NIH) generated $2.56 in economic activity for every $1.00 invested in research funding. Radiation oncologists therefore are asking lawmakers for robust federal investment in the research that drives cancer care, specifically through the National Institutes of Health (NIH), the National Cancer Institute (NCI) and the Advanced Research Projects Agency for Health (ARPA-H). Read more about ASTRO’s commitment to increasing federal cancer research funding.

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About the Survey

An online survey was sent via email in April 2025 to all 4,168 U.S.-based, non-emeritus radiation oncologists in ASTRO’s member database; 675 physicians responded (16.2% response rate), and respondents were representative of the national ASTRO membership. Further details are available from [email protected].

Additional findings:

• Doctors in rural communities (77%) and those at independent freestanding centers (75%) were more likely to predict significant (vs. modest, minimal or no) reductions in patient access with additional Medicare cuts (68% overall).

• Nearly two-thirds of the doctors (63%) said an additional 4-5% cut would severely impact their practice’s viability (32% would be moderately impacted).

• One in five doctors (20%) said a more modest cut of 1-3% cut would still have a severe impact on their practice’s viability – rising to one in four (26%) when looking at doctors in rural areas.

• Nine in 10 doctors (89%) said a more severe 6% cut would lead to practice downsizing. Most (51%) also said this level of cut would force them to close, consolidate, leave or sell their practice.

ABOUT ASTRO
The American Society for Radiation Oncology (ASTRO) is the largest radiation oncology society in the world, with 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. Radiation therapy contributes to 40% of global cancer cures, and more than a million Americans receive radiation treatments for cancer each year. For information on radiation therapy, visit RTAnswers.org. To learn more about ASTRO, visit our website and media center and follow us on social media.