The Centers for Medicare and Medicaid Services (CMS) proposed the Centers for Medicare and Medicaid Innovation Center’s Radiation Oncology (RO) Alternative Payment Model Final Rule in July 2019. While initially finalized in September 2020 for a January 1, 2021 start date, the pilot program intended to test an episodic payment model for radiotherapy services has been further delayed to start January 1, 2022.
With the new Administration, CMS is still finalizing several details of the model and considering potential modifications. As initially proposed, the pilot program will reimburse a bundled payment for select radiotherapy services rendered within a 90-day period. The model is mandatory for all radiotherapy facilities located in the randomly selected zip codes distributed by CMS, with a few exceptions defined in the previously released final rule. The final rule states that an estimated 30% of all radiotherapy episodes will be included in the model. Payment rates are site-neutral and determined by the disease site treated, with 16 of the most commonly treated disease sites included in the model.
As CMS works to finalize details of the model, Varian is continuing to work closely with the physician community and relevant stakeholders to advocate for needed changes to ensure a successful pilot program for our customers and patients.
For additional details about the final RO APM rule, please see the resources included below:
Varian Advocacy Efforts
Varian’s Government Affairs Department has been working very closely with ASTRO and other stakeholders to continue advocating for needed changes to the RO APM. While the recently announced delay is appreciated, we continue our efforts to advocate for additional changes necessary for ensuring that mandated participants are prepared to participate successfully in this model while delivering the best clinical care to their patients.
Two issues of immediate concern:
- Congress and/or Medicare should reduce the size of the payment cuts included in the proposal to no more than 3%, as they are currently larger than any other similar payment models.
- CMS has not yet finalized the clinical data elements collection and reporting requirements. Varian is advocating for CMS to release those requirements soon to give model participants time to prepare.
For more information about joining our advocacy efforts, please visit the Grassroots Portals below:
CTSI consulting services for RO APM
CTSI Oncology Solutions, a Varian company, is offering consulting services related to implementing the RO APM for providers located in selected zip codes. As part of this service, CTSI’s Revenue Cycle Solutions team would work with participants to assess:
- Adherence to treatment standards of care by disease site based on ASTRO, ACR, and ACRO recommendations
- The financial impact of a bundled payment model based on a retrospective review of provider billing
- Suggestions for changes to front and back end office process to manage RO APM patients
- Educational webinars on “best practices”
- Patient education tools
Also, an ongoing partnership has been designed to last the full length of the five-year test period to include quarterly and annual reviews and updates to all reports to determine the model's ongoing impact. Please contact Mike Dresen to schedule a call to discuss in more detail!
At Varian we support our customers successful participation in the CMS Radiation Oncology Alternative Payment Model. ARIA® Oncology Information System is equipped to capture data necessary for participation in the RO-APM. We will also provide our customers with a data reporting solution. Through the use of ARIA OIS and our Professional Services, Varian will be beside you every step of the way.
Learn more about ARIA Oncology Information System.