As Medicare once again prepares to delay a new payment model several years in the making, Houston radiation oncologist Andrew Farach, MD, is applauding that decision, saying its current version doesn’t give small and rural practices a fair shake.
The Centers for Medicare & Medicaid Services (CMS) recently proposed delaying indefinitely the implementation of a new radiation-oncology model designed to improve care for cancer patients receiving radiotherapy, as well as streamline the payment process. Once implemented, it would use quality measures, clinical data reporting, and patient experience to determine payments.
Dr. Farach, past president of the Texas Radiological Society, says the model is a step in the right direction, away from fee-for-service and toward value-based care. But he welcomes this news, which buys time for CMS to address “very evident” problems with the model and for physicians to prepare for its implementation.
“The delay, to a certain extent, gives [physicians] some relief because there’s uncertainty with a new model and reporting requirements,” he said.
The model also would test whether prospective, episode-based payments lower Medicare costs while preserving or enhancing the quality of care for Medicare patients. Under a prospective payment setup, CMS pays physicians a fixed payment in advance. It’s then up to the physicians to provide care that is cost-effective. Episode-based payment is rendered for the entirety of care provided to treat a condition or perform a certain procedure, as opposed to paying for each service individually.
CMS’ announcement arrives after a series of delays. Congress passed the Consolidated Appropriations Act in December 2020, which prohibited implementation of the radiation oncology payment model before the start of 2022. Late last year, federal lawmakers passed another piece of legislation – the Protecting Medicare and American Farmers from Sequester Cuts Act – which delayed implementation until after Jan. 1, 2023.
Also in late 2021, the CMS Innovation Center launched a strategy refresh, which calls for future payment models to address health inequities.
Dr. Farach would like to see the radiation-oncology payment model updated to ensure small, rural practices are able to succeed despite lacking the same overhead, resources, and technology as their larger, urban counterparts.
“Hopefully, with better stakeholder input … we can develop a model that accomplishes quality and money savings without putting our most vulnerable patient population at risk of having limited access to care,” he said.
Emma Freer
Associate Editor
(512) 370-1383