CMS proposes indefinite delay of Medicare radiation oncology model

The Centers for Medicare and Medicaid Services wants to indefinitely delay the start of its radiation oncology payment model and announce a new time line through future rulemaking, the agency disclosed Wednesday.

CMS also indicated it may consider scaling down the model’s discount factor, which is the amount by which it reduces a episode payments to reserve savings for Medicare.

The model cannot start before Jan. 1, 2023, per a law passed last year to forestall pending Medicare reimbursement cuts. The radiation oncology initiative was originally slated to begin Jan. 1, 2021, and had already been pushed back multiple times.

The mandatory model, managed by the Center for Medicare and Medicaid Innovation, is intended to test whether prospective, site-neutral, episode-based payments for radiotherapy can save Medicare money while preserving or enhancing quality of care. The plan is to experiment with this approach in limited geographic areas.

CMS continues to believe the model would improve radiotherapy delivery and payment and it has backers among some providers and suppliers, according to a Federal Register notice.

But considering legislative postponements, the resources required to implement it and the critical views among key interest groups, CMS now wants to initiate a fresh rulemaking process and set a start date at least six months after a new rule is published.

“Delaying the [Radiation Oncology] Model indefinitely will give RO participants the ability to pause their efforts to prepare for implementation of the RO Model. We welcome additional dialogue with RO participants and stakeholders about Medicare payment for [radiotherapy] services,” the Federal Register notice says.

Oncology providers opposed the program, arguing it would impose too much financial risk and stifle innovation. Provider groups including the American Hospital Association have also urged revisions, including a lower discount factor.

If discounts are set below 3.5% for the professional component of the model and 4.5% for the technical component, CMS would need to expand its geographic scope, the agency wrote in the notice. Episode payments would be split into professional and technical components to account for use within different claims systems.

“We believe that some stakeholders will not support the RO Model test moving forward with unchanged discounts,” CMS wrote. “These stakeholders have also requested that we not increase the geographic scope of the model,” CMS added.