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Analysis

CMS Proposing Bundled Payment Model for Radiation Oncology

By Steven Porter  
   July 10, 2019

Participation would be mandatory for certain geographic areas during the model's projected five-year timeline.

A new episode-based payment model for cancer treatments may come as soon as January 1, with mandatory participation in certain parts of the country.

The Centers for Medicare & Medicaid Services announced Wednesday that it is proposing to launch a radiation oncology model that would make prospective payments to cover radiotherapy services, in 90-day episodes, for patients diagnosed with 17 types of cancer.

The model would link payment to quality metrics and would require participation in randomly selected geographic areas, CMS said. It would also qualify as an Advanced Alternative Payment Model (APM) and Merit-based Incentive Payment System (MIPS) APM under the Quality Payment Program (QPP).

The goal is to test whether issuing episodic payments in a prospective and site-neutral fashion would reduce the amount Medicare spends on radiation services while maintaining or even improving quality, according to a CMS fact sheet.

Payments would come in two parts: a professional component to cover the radiotherapy services that may be furnished only by a physician and a technical component to cover equipment, supplies, personnel, and related costs that are not furnished by a physician, according to the fact sheet.

Health and Human Services Secretary Alex Azar had indicated last fall that the Trump administration—which had previously shied away from mandatory models—was "actively exploring" possible models for radiation oncology and other services.

Paul Harari, MD, board chair for the American Society for Radiation Oncology (ASTRO), said in a statement that the CMS proposal is "a step forward in allowing the nation's 4,500 radiation oncologists to participate in the transition to value-based care" to improve cancer patients' health outcomes.

"We believe that once implemented with modifications, the model will incentivize higher quality, more convenient radiation treatments for patients and support their journey toward a cure," Harari said.

The ASTRO statement suggested the group has reservations about required participation, which echoes a concern raised last fall by ASTRO CEO Laura Thevenot.

The proposed five-year model outlined Wednesday, which is projected to begin either January 1 or April 1 next year and run through 2024, would be managed by the CMS Innovation Center, under legal authority established by the Affordable Care Act.

The agency released a draft of the proposed rule that is being processed for publication in the Federal Register. Public comments on the proposal will be accepted for 60 days.

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

The model would make prospective payments linked to quality metrics.

The goal is to test whether such payments can improve health outcomes.

An industry association said the model should launch 'with modifications.'


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