Radiation Therapy APM Released – July 10, 2019

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On July 10, 2019, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule entitled, “Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures.”  Within that draft regulation, CMS proposes a new alternative payment model (APM) for radiation oncology providers.  We are grateful that CMS has listened to several of ACRO’s concerns relating the model, including:

  • The implementation of a prospective case rate model (rather than a retrospective model);
  • Adequate reimbursement in the form of site-neutral reimbursement based on the OPPS;
  • Coverage of most forms of cancer and modalities; and
  • 90-day episodes of care.

We will continue to review the regulation, in particular with respect to interactions it may have with the upcoming 2020 Physician Fee Schedule and Hospital Outpatient PPS Proposed Rules, as well as the “freeze” contained in the Patient Access and Medicare Protection Act (PAMPA) and Bipartisan Budget Act of 2018.

To review the regulation, please click on this link:
https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-14902.pdf

A fact sheet is available here:
https://www.cms.gov/newsroom/fact-sheets/proposed-radiation-oncology-ro-model