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CMS delays implementation of new radiation oncology payment model

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Last December, the U.S. Congress passed a bill to delay the implementation of a new radiation oncology model, while also delaying Medicare’s 6% reductions in payment for physicians who were due to enter into effective January 1. And now, Wednesday, March 6, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would indefinitely delay the implementation of the previously planned new radiation oncology bundled payment model, undated dunning specified.

This CMS decision recognizes legislation passed in December that would have required a postponement of implementation until January 2023 in any case. In making their announcement on Wednesday, CMS officials acknowledged this, writing that “The Protecting American Medicare and Farmers from Receivership Cuts Act (PL 117-71) enacted December 10, 2021 included a provision that prohibits implementation of the radiation oncology model until January 1, 2023. Thus, the RO model did not begin on January 1, 2022. On April 6, 2022, CMS published a proposed rule in the Federal Register, CMS-5527-P2, which proposes to delay the current start date of the RO model to a date to be determined through future regulation. Please reference proposed rule CMS-5527-P2 here: https://www.federalregister.gov/public-inspection/2022-07525/radiation-oncology-model. The public comment period for the RO NPRM template (CMS-5527-P2) ends on June 7, 2022.”

CMS officials noted that “the radiation oncology (RO) model aims to improve the quality of care for cancer patients receiving radiation therapy (RT) and move towards a simplified and predictable payment system. The RO model tests whether prospective, site-neutral, modality-independent, episode-based payments to group medical practices (PGPs), hospital outpatient departments (HOPDs), and stand-alone radiotherapy centers for episodes RT care reduces Medicare expenditures while preserving or improving the quality of care for Medicare beneficiaries. The Consolidated Appropriations Act of 2021 (HR 133) enacted on December 27, 2020 includes a provision that prohibits the implementation of the RO model before January 1, 2022. CMS has resolved this delay through the development of notice rules and of comments in the CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rules (CMS-1753-E).

In addition, CMS officials noted that “there is a substantial cost to continue to fund the preparation for the implementation of the [Radiation Oncology] Model in 2023. For example, funding is needed for CMS to prepare for participant onboarding, changes to claims systems, and updates to the data used in model design and participant-specific payout amounts , among a number of other activities. CMS added that spending funds on the model, which could be delayed again, could take resources away from other payment models. The delay is intended to help model participants who have invested funds to prepare for the model. Given the multiple delays and uncertainty as to the timing of the [Radiation Oncology] The model will indefinitely provide…participants with the opportunity to suspend their efforts to prepare for the implementation of the [Radiation Oncology] model,” CMS officials said Wednesday.

Leaders of the American Society for Radiation Oncology (ASTRO) released a statement on Wednesday applauding the delay. It began like this: “The American Society for Radiation Oncology (ASTRO) has released the following statement from ASTRO Board Chair Laura A. Dawson, MD, FASTRO, in response to the Centers for Medicare and Medicaid Services (CMS) to Delay the Launch of the Alternative Payment Model in Radiation Oncology (RO-APM): “The Centers for Medicare and Medicaid Services today postponed the start date of the Alternative Payment Model in Radiation -oncology from January 1, 2023 to a date to be determined through future regulation,” ASTRO executives said, “ASTRO remains hopeful that during this process, CMS will also make the adjustments recommended by Congress and the broad coalition of stakeholders within the radiation oncology community, as we remain concerned that the model in its current form is too punitive for clinics.”

ASTRO executives went on to say, “We remain committed to value-based care in radiation oncology. We believe the changes proposed by ASTRO and the radiation oncology community will ensure successful physician and facility participation and produce significant savings for the Medicare program. We continue to believe that episodic payments for radiation therapy services have great potential to improve quality and equity while reducing the costs of cancer care, and we will continue to advocate for proposals that achieve these goals.

Elements of the planned program had long been controversial in some circles. As senior editor David Raths wrote last September, “The American Society for Radiation Oncology (ASTRO) urges the Centers for Medicare and Medicaid Services (CMS) to reconsider fee schedule policy changes of 2022 physicians and the value-based radiation oncology model of care ASTRO, which has more than 10,000 members, argues in letters to CMS that the policies will result in $300 million in cuts in cancer care: $140 million in cuts due to several policy changes in the 2022 Medicare Physician Fee Schedule and cuts of $160 million over five years under the mandatory radiation model. oncology (RO model).

“This double whammy will be devastating to our patients and radiation oncology teams, jeopardize patient access to lifesaving treatment, and threaten the viability of clinics still reeling from the COVID-19 pandemic,” wrote Thomas J. Eichler, MD, Chairman of ASTRO’s Board of Directors, in a statement at the time. “Payment rates for some radiation therapy treatments for breast and prostate cancer will drop by around 13%, for example, and more than 22% for advanced lung cancer treatment.”

Moreover, as Raths wrote, ASTRO officials said last fall that they described themselves as “confused and disappointed” that the proposed policies “contrast so starkly with President Biden’s goals of ‘putting end cancer as we know it” and advance health equity. . They say the cuts will jeopardize the ability of patients to get cutting-edge cancer care close to home, with practices treating the underserved populations hardest hit by the cuts. Patients in rural areas risk losing access to cancer treatment in their communities, forcing long and costly journeys to receive care. And it comes at a time when cancer incidence rates are rising due to screening delays related to COVID-19, ASTRO says.

In addition, Raths wrote last fall, “ASTRO recommends that cancer radiation treatments be held immune from payment reductions due to updated clinical labor rates in the fee schedule. “We are also asking that the OR model discount factors be reduced to 3% to ensure access to care for patients in the 950 hospitals and community clinics required to participate in the model, while ensuring that Medicare achieves a reasonable level savings,” ASTRO’s Eichler wrote at the time.