he Centers for Medicare and Medicaid Services (CMS) published the “Specialty Care Models to Improve Quality of Care and Reduce Expenditures (CMS-5527)” final rule.

Getty Images


September 29, 2020 — On Sept. 18, 2020, the Centers for Medicare and Medicaid Services (CMS) published the “Specialty Care Models to Improve Quality of Care and Reduce Expenditures (CMS-5527)” final rule. The final rule includes a mandatory radiation oncology (RO) Model and End-Stage Renal Disease Treatment Choices Model. CMS believes these models will further their goal of shifting away from payment for volume of services alone and toward paying for value and outcomes. The RO Model will qualify as an advanced alternative payment model under the Quality Payment Program.

The RO Model will begin Jan. 1, 2021 and will run through Dec. 31, 2025. Certain radiation therapy (RT) providers and RT suppliers that furnish RT services within randomly selected Core Based Statistical Areas (geographic areas determined by zip code) are required to participate in the RO Model. The RO Model will include 30% of RO episodes in eligible geographic areas. The list of mandatory participants can be found on the RO Model website under “Participating Zip Code List.”

Under the RO Model, Medicare will pay participating providers and suppliers a prospective, site-neutral, episode-based payment for specified technical and professional RT services furnished during a 90-day episode to Medicare fee-for-service beneficiaries diagnosed with 16 different cancer types. An episode will only be triggered if there is an initial treatment planning service and at least one radiation treatment service within 28 days. Furthermore, another episode may not be triggered until at least 28 days after the previous episode has ended, referred to as the “clean period.” The base payment amounts for RT services included in the model will be the same for hospital outpatient departments and freestanding radiation therapy centers.

The American College of Radiology (ACR) will join the American Society for Radiation Oncology (ASTRO) in urging CMS and Congress to significantly delay the start date of the RO Model. Despite recommendations from ASTRO and the ACR to allow providers at least six months from the publication of the final rule to implementation due to the impacts of the COVID-19 public health emergency, CMS’ final rule only allows providers three and a half months to prepare for implementation. On Sept. 18, ASTRO issued a statement calling for additional reforms to the model along with delay in implementation. ASTRO stated that although mandatory participation representing 30% of eligible RO episodes is a positive step from the proposed 40%, this final rule goes too far for an untested model. The ACR strongly supports ASTRO’s statement and will be partnering in advocacy efforts.

Read the ACR initial summary on the model.

Related Radiation Oncology Content:

ASTRO responds to CMS Radiation Oncology Model

Related Content

News | Stereotactic Body Radiation Therapy (SBRT)

October 24, 2021 — High-dose radiation therapy can be used to lengthen progression-free survival for people with ...

Time October 24, 2021
arrow
News | Radiation Therapy

October 24, 2021 — People with liver cancer awaiting transplantation could benefit from non-invasive radiation ...

Time October 24, 2021
arrow
News | Radiology Business

October 22, 2021 — Blue Wolf Capital Partners LLC, a New York-based private equity firm, today announced it has entered ...

Time October 22, 2021
arrow
News | Radiation Therapy

October 22, 2021 — At this year’s ASTRO 2021 event, GE Healthcare will showcase over 15 innovative multi-modality ...

Time October 22, 2021
arrow
News | Proton Therapy

October 22, 2021 — RaySearch Laboratories AB and Mevion Medical Systems, two companies that are leading the field of ...

Time October 22, 2021
arrow
News | Radiation Oncology

October 22, 2021 — Eighty-five members of Congress have joined together to issue bipartisan, bicameral oversight letters ...

Time October 22, 2021
arrow
News | Intensity Modulated Radiation Therapy (IMRT)

October 22, 2021 — RefleXion Medical, a therapeutic oncology company pioneering biology-guided radiotherapy* (BgRT) as a ...

Time October 22, 2021
arrow
News | Oncology Information Management Systems (OIMS)

October 22, 2021 — The latest versions of RayStation (11A) and RayCare (5A) were released in May 2021. A new feature in ...

Time October 22, 2021
arrow
News | Radiation Oncology

October 21, 2021 — Novocure announced 15 presentations on Tumor Treating Fields (TTFields) will be featured at the ...

Time October 21, 2021
arrow
News | Radiation Therapy

October 21, 2021 — Advanced Radiation Therapy, LLC (ART) and Apollo Healthcare have announced a strategic partnership ...

Time October 21, 2021
arrow
Subscribe Now