News | Radiation Oncology | September 21, 2020

Final rule includes mandatory participation for nearly 1,000 practices and does not allow sufficient time for transition

Final rule includes mandatory participation for nearly 1,000 practices and does not allow sufficient time for transition

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September 21, 2020 — In response to the September 18 announcement by the Centers for Medicare and Medicaid Services (CMS) to establish an advanced alternative payment model (APM) for radiation oncology practices starting January 1, 2021, the American Society for Radiation Oncology (ASTRO) issued the following statement from Theodore L. DeWeese, M.D., FASTRO, Chair of the ASTRO Board of Directors:

"Achieving value-based care in radiation oncology that improves outcomes for cancer patients has been a longstanding goal of ASTRO. The final Radiation Oncology Model announced today by the Center for Medicare and Medicaid Innovation begins moving the specialty in that direction but fails to address many of the radiation oncology community's key concerns.

Requiring practices to participate and then forcing them to start the model on January 1, 2021, is untenable for practices already enduring staff shortages and other challenges due to the COVID-19 pandemic. The transition to value-based payment will require significant practice changes and investments to comply with the model's requirements. ASTRO strongly urges CMS to significantly delay the start date rather than foster unnecessary chaos and burden for the practices this model is designed to support. ASTRO also will be asking Congressional leaders to delay the RO Model via legislation before the end of the year.

ASTRO appreciates that CMS accepted some of the radiation oncology community's recommendations to minimally reduce the severe payment cuts from the initial proposal; however, we believe the Agency should have made additional modifications. For example, mandatory participation representing 30% of all radiation oncology episodes, while a positive step from the 40% originally proposed, still goes too far for an untested model and runs counter to our recommendation that CMS launch the model as voluntary, then transition to a mandatory model that includes opt-outs for low-volume practices and hardship exemptions.

ASTRO has worked with CMS and bipartisan legislators for several years toward a viable payment model for radiation oncology that would support stable and fair payments, drive adherence to nationally recognized clinical guidelines and improve patient care. We are hopeful that CMS and Congress are open to reconsidering a start date that would be realistic and not derail this unique opportunity. We also look forward to working with the Agency to improve future iterations of the model to ensure that patient access to radiation therapy services is not limited."

ASTRO's health policy experts are currently completing an in-depth analysis of the model. Additional comments and updates will be posted to

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