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HHS implements new Radiation Oncology Payment Model

Sep 21, 2020

Details regarding a new Medicare payment model for radiation oncology care have been released by the Department of Health and Human Services (HHS). The new Radiation Oncology Model (RO Model) qualifies as an Advanced Alternative Payment Model (APM) and a MIPS APM under the Quality Payment Program.

According to this release from HHS, the RO Model aims to “promote quality and financial accountability for providers and suppliers of radiotherapy.” The model has a five-year performance period and will begin January 1, 2021, running through December 31, 2025.

The RO Model will apply to the treatment of 16 different cancer types, seeking to reward high-quality, patient-centered care. The release notes that the 16 cancer types  were selected because they are commonly treated with RT, and therefore HHS feels that these specific RT services can be accurately priced for the purposes of a prospective episode payment model.

The model will test whether bundled, prospective, site neutral, episode-based payments to providers, including physician groups, outpatient departments, and freestanding radiation therapy centers, reduces Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries. More information is available from CMS here.

Episode payments will be paid prospectively in the RO Model, meaning half of the episode payment amount is paid when the episode is initiated, and the second half is paid when it concludes. Participant-specific payment amounts are determined based on national base rates, trend factors, and adjustments for each RO participant’s case-mix, historical experience, and geographic location.

RO participants have the ability to earn back a portion of the quality and patient experience withholds based on clinical data reporting, quality measure reporting and performance, as well as consumer survey results. The standard beneficiary coinsurance and sequestration policies remain in effect.

CMS has acknowledged that there may be instances of overlap with this program and other CMS programs. Yet, the release states that HHS believes the RO Model is compatible with existing models and programs that provide opportunities to improve care and reduce spending, especially episode payment models like the Oncology Care Model. HHS will work to resolve any overlapping issues—such as repetitive services or duplicative payment of services—should they arise.

For more information on new care models, visit the HHS ruling here.

More details regarding the RO Model are available from CMS here.

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