Oncologists are looking to Congress for relief after having little luck in convincing the Biden administration to change the mandatory radiation oncology model that the American Society for Radiation Oncology says will hurt more than half of forced participants.
CMS Innovation Center Director Liz Fowler recently disagreed with the radiologists’ take on the demo, and said it is a solid model.
“In some cases, they may see an increase, but that’s not who we’re necessarily hearing from. But I also understand — and I have done many meetings on that issue and I understand where they’re coming from and their concerns — but I also think that the model is a solid one and hopefully will lead to positive results for patients,” Fowler told reporters Tuesday (Oct. 5).
The Trump-era, mandatory radiation oncology demonstration introduced last year hasn’t changed much under the new administration’s proposed 2022 hospital outpatient prospective pay rule, released July 19.
The proposed demonstration would provide bundled payments for a 90-day episode of care to certain radiotherapy providers and suppliers furnishing radiotherapy for: anal cancer, bladder cancer, bone metastases, brain metastases, breast cancer, cervical cancer, CNS tumors, colorectal cancer, head and neck cancer, lung cancer, lymphoma, pancreatic cancer, prostate cancer, upper gastrointestinal cancer and uterine cancer. Providers in randomly selected locations across the country would participate in the mandatory model.
The American Society for Radiation Oncology says Fowler isn’t hearing from the oncologists who are set to gain more money under the program because there are so few.
ASTRO says HHS’ estimated impact supports the advocates’ findings that only 15% of physician group practices participating in the mandatory demo and 20% of participating hospital outpatient departments will see their pay increase. More than 60% of participating physician group practices and 72% of hospital outpatient departments will see a pay cut.
Radiation oncologists will have to wait for the Biden administration to finalize its hospital outpatient prospective pay rule to find out whether their push to reduce the discount factors in the model has ultimately been successful.
In the meantime, ASTRO is gathering support from lawmakers to counter the administration if it decides to keep the deep cuts to radiation oncologists’ pay under the mandatory model and Medicare Physician Fee Schedule.
“We know that physicians overall — not just radiation oncology — are facing a huge cliff in terms of numerous cuts and we’ve been pleased to see that Congress has been very responsive to those concerns,” Dave Adler, ASTRO’s vice president for advocacy, said. “We hope that Congress will support physicians broadly and, of course, support radiation oncology physicians and prevent these cuts from making it through, and for the RO model, to reduce those discount factors, not kill the model.”
Lawmakers have previously interfered with the model, stepping in at the end of 2020 to delay the model’s start date until Jan. 1, 2022. CMS originally agreed to give providers until July 1, 2021 after pushback from oncologists. — Dorothy Mills-Gregg (dmillsgregg@iwpnews.com)
Oncologists Turn To Congress As Fowler Supports Radiation Model
Inside Health Policy
October 14, 2021 2:44 pm
Oncologists are looking to Congress for relief after having little luck in convincing the Biden administration to change the mandatory radiation oncology model that the American Society for Radiation Oncology says will hurt more than half of forced participants.
CMS Innovation Center Director Liz Fowler recently disagreed with the radiologists’ take on the demo, and said it is a solid model.
“In some cases, they may see an increase, but that’s not who we’re necessarily hearing from. But I also understand — and I have done many meetings on that issue and I understand where they’re coming from and their concerns — but I also think that the model is a solid one and hopefully will lead to positive results for patients,” Fowler told reporters Tuesday (Oct. 5).
The Trump-era, mandatory radiation oncology demonstration introduced last year hasn’t changed much under the new administration’s proposed 2022 hospital outpatient prospective pay rule, released July 19.
The proposed demonstration would provide bundled payments for a 90-day episode of care to certain radiotherapy providers and suppliers furnishing radiotherapy for: anal cancer, bladder cancer, bone metastases, brain metastases, breast cancer, cervical cancer, CNS tumors, colorectal cancer, head and neck cancer, lung cancer, lymphoma, pancreatic cancer, prostate cancer, upper gastrointestinal cancer and uterine cancer. Providers in randomly selected locations across the country would participate in the mandatory model.
The American Society for Radiation Oncology says Fowler isn’t hearing from the oncologists who are set to gain more money under the program because there are so few.
ASTRO says HHS’ estimated impact supports the advocates’ findings that only 15% of physician group practices participating in the mandatory demo and 20% of participating hospital outpatient departments will see their pay increase. More than 60% of participating physician group practices and 72% of hospital outpatient departments will see a pay cut.
Radiation oncologists will have to wait for the Biden administration to finalize its hospital outpatient prospective pay rule to find out whether their push to reduce the discount factors in the model has ultimately been successful.
In the meantime, ASTRO is gathering support from lawmakers to counter the administration if it decides to keep the deep cuts to radiation oncologists’ pay under the mandatory model and Medicare Physician Fee Schedule.
“We know that physicians overall — not just radiation oncology — are facing a huge cliff in terms of numerous cuts and we’ve been pleased to see that Congress has been very responsive to those concerns,” Dave Adler, ASTRO’s vice president for advocacy, said. “We hope that Congress will support physicians broadly and, of course, support radiation oncology physicians and prevent these cuts from making it through, and for the RO model, to reduce those discount factors, not kill the model.”
Lawmakers have previously interfered with the model, stepping in at the end of 2020 to delay the model’s start date until Jan. 1, 2022. CMS originally agreed to give providers until July 1, 2021 after pushback from oncologists. — Dorothy Mills-Gregg (dmillsgregg@iwpnews.com)