The provision delays the start of the Radiation Oncology Advanced Payment Model (RO Model), a proposal to change the way the U.S. Centers for Medicare and Medicaid Services pays for radiation therapy procedures. The original release of the RO Model in September proposed that the changes go into effect on January 1, 2021, but that was delayed for six months after radiation therapy groups said they wouldn't have time to prepare for the changes. They will now have until January 2022 until the RO Model takes effect.
Radiation therapy providers would get even more time to prepare under the legislation passed yesterday. The RO Model proposes to change radiation therapy reimbursement from a model based on fee-for-service to one based on a 90-day episode of care, with one bundled payment made for all treatments received during that period.
Proponents of radiation oncology payment reform believe that paying providers for each instance of service creates financial incentives to administer more treatment sessions, which can be inconvenient for patients.
In addition to the change in implementation date, a group of 16 members of Congress signed a letter to Alex Azar, secretary of the U.S. Department of Health and Human Services, calling for changes to the substance of the RO Model. The letter notes that the RO Model "will completely transform Medicare reimbursement for mandated participants" and that the version of the system released by CMS in September does not reflect the input of radiation therapy experts that was submitted during the drafting of the rules.
For example, the proposed rule for the RO Model called for a discount factor of 4% for the professional component and 5% for the technical component; these factors were reduced only slightly in the final rule. The end result could be a reduction of 6% to physician group practices and 4.7% to hospital outpatient departments, the letter states.
The letter also cites the financial woes faced by many radiation therapy providers during the COVID-19 pandemic -- a reality that should be reflected in the RO Model.
"If designed appropriately, the RO Model can be an excellent opportunity to test bundled payments, modernize Medicare to keep up with clinical advancements, and provide more stability in radiation oncology payments," the letter states. "Our concern is that instead the RO Model, as currently constructed, could impede the original goals of improving health outcome to cancer patients."
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