The RO Model will test whether bundled, prospective, site-neutral, and episode-based reimbursement can reduce Medicare expenditures while preserving or enhancing the quality of care.
By Matt Devino, MPH
On October 13, ACCC President Randall Oyer, MD, sent on behalf of ACCC a letter to Alex Azar, Secretary of the U.S. Department of Health and Human Services, and Seema Verma, Administrator of the Centers for Medicare and Medicaid Services, responding to CMS’ final rule for the Radiation Oncology (RO) Model. The RO Model aims to improve the quality of care for patients with cancer who are receiving radiotherapy (RT) by moving toward a simplified and predictable payment system.
The RO Model will test whether bundled, prospective, site-neutral, modality agnostic, and episode-based reimbursement can reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries. These newly configured payments will reimburse physician group practices, hospital outpatient departments, and freestanding radiation therapy centers for radiotherapy episodes of care.
CMS originally set the five-year RO Model performance period to begin January 1, 2021. After receiving feedback from numerous stakeholders (including ACCC), the agency announced on October 21, 2020 that it was moving the start date to July 1, 2021. CMS states that it is currently pursuing rulemaking to make this change.
In his letter to CMS, Dr. Oyer stated ACCC’s concern about the original deadline for implementing the RO Model. Cancer programs have been and continue to be, wrote Dr. Oyer, severely affected by COVID-19, and they should not be required to implement a new initiative during the pandemic. By significantly delaying the start of the RO Model, said Dr. Oyer, CMS will be better able to guarantee its success, minimize the burden on providers, and ensure that patients receive the care they need.
Discount Factors
Dr. Oyer also urged CMS to reduce the model’s discount factors to no more than 3 percent. While ACCC supports the RO Model’s concept and premise, the association continues to have serious reservations about it. Given the model’s steep payment cuts, they are more likely to hurt—rather than improve—quality care. In particular, said Dr. Oyer, the discount factor cuts of 3.75 percent and 4.75 percent for professional and technical services, respectively, are out of alignment with other alternative payment models and the Medicare Access and CHIP Reauthorization Act. The final rule estimates cuts of 6 percent to participating group practices and 4.7 percent to hospital outpatient departments.
Dr. Oyer also stated that an ACCC analysis revealed virtually no upside potential for required participants, as any hint of “payment stability” is negated by the discount factors and withholds. Given this, ACCC has urged CMS to reduce the discount factors to no more than 3 percent.
Patient Access
Finally, wrote Dr. Oyer, ACCC believes that CMS should address the disproportionate impact that the RO Model will likely have on patient access to care. It is likely, said Dr. Oyer, that the model will have a disproportionate impact on patient access to radiation therapy in cancer programs that have a high number of Medicare beneficiaries—particularly in rural and underserved areas. ACCC recommended that CMS perform a study on the impact this model will have on patient access to care before its implementation.
The rule states that practices with fewer than 20 episodes in the previous year may opt out of the RO Model. Dr. Oyer wrote that ACCC believes that this threshold is so low, few if any selected facilities would qualify. ACCC continues to urge CMS to work with the stakeholder community to develop a more appropriate opt-out mechanism that recognizes the challenges faced by small, rural practices.
For more information on the RO Model final rule, see these CMS resources:
