News | Radiation Therapy | May 16, 2024

Bipartisan bill to modernize radiation oncology reimbursement introduced in Congress

Bipartisan bill to modernize radiation oncology reimbursement introduced in Congress

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May 16, 2024 — Today marks a significant milestone in cancer care with the introduction of bipartisan federal legislation that would revolutionize Medicare reimbursement for radiation therapy. The Radiation Oncology Case Rate (ROCR) Value-Based Payment Program Act of 2024, sponsored by Sen. Thom Tillis (R-N.C.) (S. 4330) and by Reps. Brian Fitzpatrick (R-Pa.), Jimmy Panetta (D-Calif.), John Joyce, MD (R-Pa.) and Paul Tonko (D-N.Y.) (House bill number pending), would protect access to high value cancer treatments for patients across the country, enhance patient outcomes and reduce health disparities while generating savings for Medicare.

The Radiation Oncology Case Rate (ROCR) program shifts Medicare’s current payment system to a more patient-centered approach. With advances in cancer treatment, evidence-based guidelines often recommend shorter courses of radiation therapy for many patients, yet Medicare’s outdated fee-for-service approach penalizes radiation oncologists for following best practices in patient care.

“ASTRO applauds Sen. Tillis, Rep. Fitzpatrick, Rep. Panetta, Rep. Joyce and Rep. Tonko for their exemplary bipartisan leadership in the fight against cancer. Through ROCR, Congress can build a future where radiation oncology reimbursement is driven by patient needs, not by the number of treatments provided,” said Jeff Michalski, MD, MBA, FASTRO, Chair of the American Society for Radiation Oncology (ASTRO) Board of Directors. “This bill represents a pivotal turn in how Medicare values radiation oncology care. By passing it, Congress would ensure that high quality treatment remains accessible for all patients, especially those in rural and underserved communities.”

A key feature of the ROCR Act is an evidence-based approach to reducing disparities in cancer treatment. ROCR’s Health Equity and Achievement in Radiation Therapy (HEART) initiative would provide cancer centers with funds to support patients who face transportation hurdles that undermine access to radiation treatments. HEART is based on a model from a National Cancer Institute-funded study that reduced disparities, improved treatment completion and increased survival rates for a community in North Carolina. ROCR expands this evidence-based policy initiative nationwide.

“It’s tragic when transportation obstacles get in the way of curing cancer. Our rural and underserved patients deserve better access, and the HEART initiative will ensure that many more Americans can benefit from radiation therapy,” said Dr. Michalski.

ROCR would also end more than a decade of cuts to Medicare payments for radiation therapy. Despite the outsized value that radiation oncology delivers for patients and Medicare, reimbursements for radiation therapy under the Medicare Physician Fee Schedule have been cut by 23% over the past decade, more than nearly any other medical specialty.

ROCR incorporates the strengths of the indefinitely-delayed Radiation Oncology Alternative Payment Model proposed by Medicare – specifically the use of episode-based payments – and addresses its shortcomings, including excessive payment cuts, burdensome administrative requirements and the absence of a path to reduce disparities.

Key features of ROCR include:

  • Leveraging episode-based payments to align financial incentives with scientifically proven outcomes.
  • Supporting shorter treatments for certain cancers, allowing patients more time to work and spend time with loved ones.
  • Reducing disparities that create barriers for patients from rural and underserved communities to access and complete treatments.
  • Implementing a systematic approach to improve quality and protect patient safety through practice accreditation.
  • Unifying payments across settings based on hospital technical payments.
  • Generating Medicare savings of approximately $200 million over 10 years.

 

“I’m proud to introduce the ROCR Act, which will provide a more stable and sustainable payment framework for life-saving radiation oncology services,” said Senator Tillis. “This legislation represents more than just the advancement of meaningful value-based payment reform; it’s a promise to those battling cancer that they’ll have uninterrupted access to high-quality care without facing financial or geographic barriers.”

“The ROCR Act is a crucial step toward reforming our health care system to better serve people with cancer,” said Rep. Fitzpatrick, co-chair of the House Cancer Caucus. “By introducing this bill, we are standing up for Americans who rely on radiation therapy as a lifeline during their most challenging times and ensuring they have access to state-of-the-art treatment through a fair and modernized payment system.”

“The current Medicare Part B payment system favors longer courses of cancer treatment and undermines the ability of radiation oncology clinics to provide tailored care,” said Rep. Panetta. “By creating a bundled payment system with our bipartisan ROCR Act, we’ll more readily incentivize high-value treatment for patients and potentially reduce the frequency of radiation sessions. We need to ensure that Medicare is providing the best care possible for beneficiaries while properly compensating providers in their work.”

“A cancer diagnosis is devastating for both a patient and their family, and no patient receiving this life-altering news should be told that some treatments are unavailable. Innovation is the bedrock of American medicine, and I’m proud to join this bipartisan group to introduce the Radiation Oncology Case Rate (ROCR) Act, which would help ensure that seniors have access to the innovative and curative therapies that they need,” said Rep. Joyce.

“I've long been a believer in the tremendous value that radiation therapy delivers for cancer patients and have worked for years to ensure fair and stable payment that supports access to high quality care,” said Rep. Tonko. “The ROCR Value-Based Care Act responds to the challenges facing our nation’s cancer clinics and patients with a sound policy solution that supports better outcomes and access across New York and America. I’m ready to work with my bipartisan colleagues and the radiation oncology community to pass the ROCR Act this Congress.”

Members of the radiation oncology community also continue to voice their commitment to payment reform. Today, ASTRO shared a list of more than 40 healthcare institutions and organizations in support of ROCR including the American Association of Physicists in Medicine, the American Association of Medical Dosimetrists, the American College of Radiology, the US Oncology Network, SERO (the Southeast Radiation Oncology Group), Providence health system and the University of Michigan. Interested institutions can join this list here.

“Collaboration between policymakers and radiation oncology stakeholders will continue to be essential to ensure the successful implementation of this pioneering program and enhance the landscape of cancer treatment across America,” said Dr. Michalski.

Radiation oncologists from across the country will travel to Washington, D.C. next week to advocate for the ROCR Act as a solution to increase access and reduce disparities in cancer care. As part of ASTRO’s Advocacy Day, more than 80 physicians representing 30 states will meet with members of Congress on Tuesday, May 21.

ASTRO urges all members of Congress to support this bill and help usher in a new era of evidence- and value-based policy solutions for cancer treatment.

For more information: www.astro.org


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