CMS Delays Radiation Oncology Start Date

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  • October 26, 2020

On October 21, 2020, CMS announced they received feedback from a number of stakeholders about the challenges of preparing to implement the Radiation Oncology (RO) Model by January 1, 2021 and as a result, they would delay the RO Model start date to July 1, 2021.

The RO Model tests whether bundled, prospective, site neutral, modality agnostic, episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD), and freestanding radiation therapy centers for radiotherapy (RT) episodes of care reduces Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries.

The design of the RO Model includes several key programmatic elements:

  1. Alternative Payment:
    1. Episode Payments:CMS makes prospective, episode-based (i.e., bundled) payments, based on a patient’s cancer diagnosis, that cover RT services furnished in a 90-day episode for the 16 cancer types meeting the included cancer type criteria described in the final rule;
    2. Site-neutrality:The Model uses site-neutral payment by establishing a common, adjusted national base payment amount for the episode, regardless of the setting where it is furnished;
    3. Professional and Technical Payment Components:Episode payments are split into professional and technical components to allow the current claims systems for PFS and OPPS to be used to adjudicate RO Model claims and for consistency with existing business relationships.
  2. Linking Payment to Quality:The Model links payment to quality using reporting and performance on quality measures, clinical data reporting, and patient experience as factors when determining payment to RO participants. The Model meets the requirements to qualify as an Advanced APM and a MIPS APM under QPP.

The four quality measures are:

  • Oncology: Medical and Radiation – Plan of Care for Pain –NQF #0383; CMS Quality ID #144
  • Treatment Summary Communication – Radiation Oncology
  • Preventive Care and Screening: Screening for Depression and Follow-Up Plan –NQF #0418; CMS Quality ID #134
  • Advance Care Plan –NQF #0326; CMS Quality ID #047

RO Participants in a Mandatory Model: The RO Model is a mandatory model that requires participation from RT providers and suppliers that furnish RT services within randomly selected Core-based statistical areas (CBSAs) to participate.

RO Model details and background are available on the Center for Medicare & Medicaid Innovation

(CMMI) Website at: https://innovation.cms.gov/innovation-models/radiation-oncology-model