CMS Proposes Indefinite Delay in Medicare Radiation Oncology Model

CMS Proposes Indefinite Delay in Medicare Radiation Oncology Model

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Centers for Medicare and Medicaid Services Hope Indefinite delay The agency disclosed Wednesday that it launched its radiation oncology payment model and announced a new timeline through future rulemaking.

CMS also said it might consider scaling down the model’s discount factor, which is the amount it reduces episode payments to preserve Medicare savings.

Under a law passed last year, the model cannot be activated before Jan. 1, 2023, to prevent pending Medicare reimbursement cuts.The radiation oncology program was scheduled to begin on January 1, 2021, and has push back multiple times.

The mandatory model, administered by the Center for Medicare and Medicaid Innovation, is designed to test whether forward-looking, neutral, event-based payments for radiation therapy can be provided while maintaining or improving the quality of care. The plan is to experiment with this approach in a limited geographic area.

According to the Federal Register notice, CMS continues to believe the model will improve the delivery and payment of radiation therapy, and it has support among several providers and suppliers.

But given the legislative delay, the resources needed to implement it and criticism among key interest groups, CMS now wants to initiate a new rulemaking process with a start date set at least six months after the new rule is published.

“put off [Radiation Oncology] The model will indefinitely enable RO participants to suspend their efforts in preparation for the implementation of the RO model.We welcome more dialogue with RO participants and stakeholders on Medicare payments [radiotherapy] service,” the Federal Register notice said.

Oncology Provider against the plan, arguing that this creates too much financial risk and stifles innovation. Vendor groups, including the American Hospital Association, have also urged revisions, including lowering the discount factor.

The agency wrote in the notice that CMS will need to expand its geographic reach if discounts are below 3.5% for the professional portion of the model and 4.5% for the technical portion. Plot payments will be divided into professional and technical sections to illustrate use in different claims systems.

“We believe that some stakeholders will not support moving forward with RO model testing without the discount,” CMS wrote. “These stakeholders also asked us not to expand the geographic scope of the model,” CMS added.

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