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Launch of Radiation Oncology Model 2021

Launch of Radiation Oncology Model 2021

CMS intends to delay the RO Model start date to July 1, 2021 based on feedback from stakeholders. The feedback includes the challenges of preparing to implement the new RO payment model by January, including revenue losses for RO participants due to decreased patient volumes and layoffs or staff reallocations due to COVID-19.

The announcement to delay the RO Model can be considered as a win for radiation oncologists, who have been calling on CMS to push back the launch date for the model because of the COVID-19 pandemic.

What is CMS Radiation Oncology Model?

CMS Radiation Oncology Model is an innovative payment model which intends to improve the quality of care for cancer patients receiving radiotherapy treatment, and move toward simplified and predictable payments.

As per the CMS’s the main objective of RO model is to check whether prospective, site neutral, bundled, modality agnostic, episode-based payments to hospital outpatient departments (HOPD), physician group practices (PGPs), and freestanding radiation therapy centers for radiotherapy (RT) episodes of care reduces Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries.

However, this RO model is criticized by many groups and their concerns are listed below:

ASTRO expressed concerns regarding model’s mandatory nature. It was mandatory for radiation therapy providers and suppliers in randomly selected core-based statistical areas starting January 1, 2021 which is postponed to July 1, 2021.

The accuracy of bundled payment prices under the model is doubtful according to The Medicare Payment Advisory Commission (MedPAC),

CMS goal is saving Medicare money on cancer care. However, the MedPAC commission said the use of hospital outpatient department payment rates to determine site-neutral base bundled payments for model participants would work against the CMS’s goals.

Various groups tried to urge CMS including the American Hospital Association (AHA)  to reconsider the financial risk levels of the model, citing misaligned risk and rewards.

This RO model is criticized by other healthcare industry groups also, which aims to test whether prospective bundled payments will reduce Medicare spending on 16 cancer types while maintaining or improving quality of care for cancer patients.

Next step of CMS incorporation of new models for value-based cancer care is The RO Model. However, a 2018 study investigating whether accountable care models had an effect on cancer care spending found an $11 difference per beneficiary, indicating that models created for primary care may not be applicable for oncology purposes.

The AHA reiterated its concerns about the RO Model and asked CMS to postpone the model’s start date until at least January 1, 2022.

Are looking for radiation oncology updates? We will keep you posted on this.

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