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CMS PROPOSES INDEFINITE DELAY FOR RADIATION ONCOLOGY MODEL ALREADY POSTPONED BY
CONGRESS

By Robert King Apr 7, 2022 11:10am
Radiation OncologyCommunity Oncology AllianceCongressValue-Based Care

The Centers for Medicare & Medicaid Services has proposed indefinitely
postponing a controversial Radiation Oncology model, which lawmakers already
delayed the start date until 2023. (rarrarorro/iStock/Getty Images Plus/Getty
Images)

The Biden administration has moved to delay indefinitely implementing the
controversial radiation oncology payment model in response to two recent delays
passed by Congress. 



The Centers for Medicare & Medicaid Services (CMS) published a proposed rule
Wednesday that said the indefinite delay will free up resources for other
alternative payment models. The delay will also enable participants to pause any
efforts to get ready for the model. 

The radiation oncology mandatory payment model is intended to reimburse oncology
practices and hospital outpatient sites for total episodes of care and will make
site-neutral payments for certain radiation therapies. 




But the model has generated major pushback from the oncology industry. The
advocacy group Community Oncology Alliance said last August the mandatory
model’s cuts will hurt oncology practices already under strain from the
pandemic. 

The alliance had asked the model to be pushed back to 2023 and the cuts to be
stopped. Congress agreed and passed legislation back in December to delay the
start date from Jan. 1, 2022, to 2023. 

If the proposed rule is finalized, the model would be on hold for an
indeterminate period of time. 



The delays from Congress played a major part in CMS’ decision.

“There is a substantial cost to continue funding preparation for implementation
of the [Radiation Oncology] Model in 2023,” the proposed rule said. “For
example, funding is needed for CMS to prepare for participant onboarding, claims
systems changes, and updates to the data used in the model’s design and
participant-specific payment amounts, among a number of other activities.”

CMS added that devoting funding to the model, which could be delayed again,
could take away resources from other payment models. 

The delay is intended to help model participants which have invested funding to
prepare for the model. 



“Given multiple delays and uncertainty about the timing of the [Radiation
Oncology] Model indefinitely will give … participants the ability to pause their
efforts to prepare for implementation of the [Radiation Oncology] model,” the
rule said. 

CMS is taking comments on the delay, any amendments to the model’s payment
methodology and other aspects of the design.

The decision drew plaudits from some oncology groups.

The American Society of Radiation Oncology hopes that CMS "makes the adjustments
recommended by Congress and the broad coalition of stakeholders within the
radiation oncology community as we remain concerned that the model in its
current form is too punitive for clinics," said Laura Dawson, chair of ASTRO's
board of directors in a statement.

PayersHospitalsPracticesRegulatoryProvidersalternative payment models
(APMs)COVID-19

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