The radiation oncology community has cause for celebration as the U.S. Centers for Medicare and Medicaid Services (CMS) decided to postpone for six months the implementation of its Radiation Oncology (RO) Model, a controversial new method of paying for radiation therapy treatments.
In an October 21 tweet, CMS Administrator Seema Verma said that CMS had listened to feedback from the radiation oncology community and "understand that more time is needed to prepare." She added that implementation of the RO Model would be delayed by six months, from January 2021 to July 2021.
The @CMSGov team & I have listened to the feedback from @ASTRO_org & the radiation oncology community regarding the start date of the new Radiation Oncology (#radonc) Model, & understand that more time is needed to prepare.
— Administrator Seema Verma (@SeemaCMS) October 21, 2020
CMS had announced the RO Model in September as a new structure for reimbursing for radiation therapy treatments for patients in the Medicare and Medicaid systems. The initiative was part of an effort by CMS to move away from the current procedure-based reimbursement structure, which it saw as creating a financial incentive for providers to require patients to return multiple times for cancer treatments.
Instead, the RO Model proposed to bundle payments to radiotherapy providers into a 90-day episode of care for a patient. It would cover 16 different cancer types, with payment amounts determined based on national base payment rates, payment trends, and adjustments for the case mix of the provider, in addition to its historical experience and geographic location.
CMS had been working with the radiation oncology community on the model, but many seemed surprised when the initiative was announced -- in particular with its implementation date of January 2021. The American Society for Radiation Oncology (ASTRO), for example, stated that while it appreciated the move to value-based care, it believed the implementation date of January 1, 2021, for the RO Model was too soon for most radiation oncology practices, especially during the COVID-19 pandemic.
In October, a coalition of radiology and radiation oncology groups asked CMS for a delay in the implementation of the model. They also predicted that the RO Model as currently proposed would result in pay cuts of 6% to participating group practices and nearly 5% to hospital outpatient departments.
The groups claimed the reimbursement cuts caused by the RO Model would be particularly burdensome during the COVID-19 pandemic, which has had significant financial impact on radiology practices and outpatient departments.
In her October 21 tweets, Verma acknowledged the importance of the RO Model as a part of the agency's strategy to strengthen Medicare and improve cancer care, "so we intend to delay the model until July 2021 through upcoming rule-making."
The move by CMS was immediately applauded by ASTRO, which said it was looking forward to working with the agency during the six-month delay to craft a better solution.
"This change is an important recognition of the radiation oncology community’s concerns, and we are pleased and thankful that Administrator Verma listened to the needs of our member radiation oncology practices during these challenging times," said Dr. Theodore DeWeese, chair of ASTRO's board of directors.
