The Centers for Medicare and Medicaid Services (CMS) released the Centers for Medicare and Medicaid Innovation Center’s Radiation Oncology (RO) Alternative Payment Model Final Rule on September 18, 2020. Proposed in July 2019, the RO APM establishes a 5-year pilot program to test an episodic payment model for radiotherapy services.

The pilot model 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 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.

While initially scheduled to start January 1, 2021 and following six-month delay, Varian has worked closely with the physician community to secure a delay of the RO Model until January 1, 2022 as outlined in the recent COVID-19 relief package.

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 Practice 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!