CMS Release Radiation Oncology Model Proposal

August 2019 ~

In July, CMS announced the release of a proposed rule for a mandatory radiation oncology (RO) bundled payment model that seeks to improve the quality of care for cancer patients undergoing radiotherapy treatment and reduce provider burden.

If finalized, the rule would implement two new mandatory Medicare payment models under section 1115A of the Social Security Act—the Radiation Oncology Model (RO Model) and the End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model).

CMS believes that these two proposed models would test ways to further their goals of reducing Medicare expenditures while preserving or enhancing the quality of care furnished to beneficiaries. According to the proposal’s text, the proposed RO Model would promote quality and financial accountability for providers and suppliers of radiotherapy (RT). The RO Model would test whether making prospective episode payments to hospital outpatient departments (HOPD) and freestanding radiation therapy centers for RT episodes of care preserves or enhances the quality of care furnished to Medicare beneficiaries while reducing Medicare program spending through enhanced financial accountability for RO Model participants.

The model has been designed to be site-neutral and will be calculated similarly regardless of whether the provider is a physician, hospital outpatient department or non-hospital setting. Under the model, participants would receive a bundled payment for 90-day episodes of radiation therapy for 17 disease sites, including breast, lung, prostate, kidney and colorectal cancer and the bundled payment would be made instead of regular Medicare fee-for-service payments. Providers would be responsible for any spending above the payment amount and will be allowed to keep any savings if spending is less than the bundled payment, subject to quality and patient experience measures.

According to CMS, the proposed ETC Model would be a mandatory payment model intended to encourage greater use of home dialysis and kidney transplants, to preserve or enhance the quality of care furnished to Medicare beneficiaries while reducing Medicare expenditures. The ETC Model would include ESRD facilities and certain clinicians caring for beneficiaries with ESRD – or Managing Clinicians – located in selected geographic areas as participants. CMS would assess the performance of participating Managing Clinicians and ESRD facilities on their rates of home dialysis and kidney and kidney-pancreas transplants during each Measurement Year (MY), and would subsequently adjust certain of their Medicare payments upward or downward during the corresponding performance payment adjustment period based on their home dialysis rate and transplant rate. CMS would also positively adjust certain Medicare payments to participating ESRD facilities and Managing Clinicians for home dialysis and home dialysis-related claims in the initial 3 years of the ETC Model.

CMS proposes to run the model for five years, beginning either January 1 or April 1, 2020. The proposed rule is expected to be published in the Federal Register soon, and CMS will accept comment for 60 days after publication.

For more information on the proposed Radiation Oncology (RO) Model, see the CMS Fact Sheet.

Source(s): Health Industry Washington Watch; Health Leaders Media; American Hospital Association; RevCycleIntelligence;