Providers are urging the Biden administration to make a drastic overhaul of a radiation oncology payment model if the agency decides to bring back the oft-delayed experiment.
Comments were due Tuesday on a Centers for Medicare & Medicaid Services (CMS) proposed rule that indefinitely delays the model, which already had its start date delayed to 2023 by Congress. Providers who have long fought the Trump-era model are worried that it could come back and call for major changes if that happens.
The model was created to reimburse oncology practices and outpatient hospital sites for total episodes of care. The mandatory model would also make site-neutral payments for specific radiation therapies. But the model has generated major industry and congressional pushback since its announcement. Various provider groups charged that the model masqueraded as a pay cut to oncology practices and hospitals.
“We believe that an overemphasis on demonstrating savings under the model has sacrificed achievable goals of quality improvement and payment stability,” said the American Society for Radiation Oncology (ASTRO) in its comments on the proposed rule.
Providers decried not just the mandatory nature of the model but also its payment methodology.
The model installed what ASTRO called a “site-neutral” test that created a national base rate for services despite where the service is furnished. The goal was to remove incentives among providers to promote one site for radiation services over...
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