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CMS approves radiation oncology payment model

by Insuredwell
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CMS’ Center for Medicare & Medicaid Innovation on Friday released its final alternative payment model for cancer patients receiving radiotherapy.

The radiation oncology model is supposed to test whether making 90-day bundled payments for radiation therapy maintains or improves the quality of care that Medicare beneficiaries receive and reduces Medicare spending compared to traditional fee-for-service. According to CMS, the pilot will save the federal government $230 million over five years. It kicks off January 1.

The agency thinks patients could benefit from fewer treatments and better outcomes under the new payment model.

“The RO Model can help patients reduce travel time required for treatment, reduce side effects, lessen the time spent in a doctor’s office or waiting room and free up time for patients to engage in other activities that can help improve their overall quality of life,” the agency said in a press release.

Oncology providers came out against the model when CMS proposed it last year, claiming the plan would put them at excessive financial risk and stifle innovation. While CMS accepted some of their recommendations, many providers don’t think the changes go far enough.

“Mandatory participation representing 30% of all radiation oncology episodes, while a positive step from the 40% originally proposed, still goes too far for an untested model and runs counter to our recommendation that CMS launch the model as voluntary,” said Dr. Theodore DeWeese, chair of the board of directors for the American Society for Radiation Oncology.

The group wants CMS to “significantly delay” the demonstration’s start, saying the COVID-19 pandemic has created staff shortages and other problems their members need to overcome before they can take part.

“The transition to value-based payment will require significant practice changes and investments to comply with the model’s requirements,” DeWeese said in a statement.

The industry group plans to ask Congress to pass legislation to delay the RO model’s start before the end of the year.

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