On April 6, the Centers for Medicare & Medicaid Services (CMS) issued a rule proposing to indefinitely delay the radiation oncology (RO) model.
The model was scheduled to begin on Jan. 1, 2023, after it was further delayed by the Consolidated Appropriations Act of 2021. The rule states that CMS will, at some future point, propose a new start date and modify the model’s performance period. The rule commits CMS to issuing this rule no less than six months prior to the proposed start date.
The RO model is designed to test whether prospective episode-based payments for radiotherapy services will reduce Medicare program expenditures and improve the quality of care for Medicare beneficiaries. Under the model, Medicare would pay participating providers and suppliers a site-neutral, episode-based payment for specified professional and technical radiotherapy services furnished during a 90-day episode to Medicare fee-for-service beneficiaries diagnosed with certain cancer types. The RO model is mandatory in selected geographic areas.
In indefinitely delaying the model, CMS cites concerns from stakeholders over the model’s design — specifically the discount rate, which is higher than similar alternative payment models. In addition, the agency cites the costs incurred by both participants and the agency to prepare for the model at a time when there is continued uncertainty over whether Congress will further delay the model.