Lawmakers delay RO model again as reps. seek to scale back ‘intensity’ of payment cuts

In a wave of changes approved by Congress Monday night, lawmakers also granted another delay of the Radiation Oncology Advanced Payment Model that was slated to start next year.

The Centers for Medicare & Medicaid Services had originally planned to kick off the mandatory bundled-payment effort in July. But with yet another extension granted this week, the effort will now launch on Jan. 1, 2022. Physician advocacy groups had lobbied hard for the change and praised the decision on Tuesday.

Sixteen lawmakers are also urging Health and Human Services to further modify the initiative amid concerns it would financially hamper providers, the American Society for Radiation Oncology said in an announcement. House members are concerned that the “intensity of the payment cuts are so significant that it could have the unintended effect of reducing quality.”

“The RO Model is a prime example of a payment model gone awry, focusing more on cutting costs than preserving quality and access,” Thomas Eichler, MD, chairman of ASTRO’s board of directors,” said Dec. 22. “Cloaked in the rhetoric of value-based care, Medicare's model will create significant cost and administrative burden for the nearly 1,000 radiation oncology practices forced to participate.”

CMS first finalized the long-awaited RO model in September. Its goal is to create more predictable payments in cancer care, incentivize the use of less costly treatment, and save $230 million over the next five years. The agency plans to do so by providing bundled payments during a 90-day episode of care to radiotherapy providers treating one of 16 different cancer types. It will require participation from physicians in randomly selected geographic areas that contain about 30% of all eligible Medicare fee-for-service radiotherapy episodes nationally.

The federal agency had already granted a previous delay earlier this month from the original start date of Jan. 1, 2021. ASTRO said that radiation oncologists are eager to join the value-based care movement, but not under the terms laid out by the federal government.

"We will continue pursuing a radiation oncology model that will improve quality and reduce costs, albeit not at the extreme level mandated by CMS,” Eichler added.