The American Society for Radiation Oncology (ASTRO) as we speak known as on the Facilities for Medicare and Medicaid Companies (CMS) to maneuver ahead urgently with the event of a radiation oncology various cost mannequin (RO-APM) following a brand new report back to Congress from the Middle for Medicare and Medicaid Innovation (CMS Innovation Middle). The CMS Innovation Middle report outlines necessary cost mannequin design issues for implementing an Superior APM in radiation oncology. ASTRO believes the report acknowledges the important thing mannequin design parts and supplies a viable path ahead to make sure the sphere of radiation oncology could be on the forefront of efforts to enhance remedy high quality and decrease prices for most cancers sufferers and the well being care system.
The CMS Innovation Middle report, “Episodic Different Fee Mannequin for Radiation Remedy Companies,” was requested by Congress as a part of the ASTRO-supported Affected person Entry and Medicare Safety Act (PAMPA) of 2015. Along with the report on an APM for radiation oncology, this bipartisan laws, which was handed unanimously by Congress, introduced much-needed stability to community-based radiation oncology clinic reimbursement by freezing funds for key radiation remedy companies at 2016 ranges by December 2018. Agreeing to an Superior APM earlier than the January 1, 2019 expiration of the PAMPA freeze will allow CMS, Congress and the radiation oncology group to keep away from the looming cost cliff.
“The sector of radiation oncology is a confirmed and wanted element of complete most cancers remedy and is well-positioned to guide efforts to reinforce the worth of most cancers care. We’re happy that the CMS Innovation Middle’s report supplies us with a considerate and actionable roadmap, and we stay up for working expeditiously with CMS on mannequin implementation previous to the PAMPA expiration,” stated Brian Kavanagh, MD, MPH, FASTRO, Chair of ASTRO’s Board of Administrators. “We consider the CMS mannequin report aligns very properly with our proposed RO-APM, which might incentivize the suitable use of most cancers therapies that outcome within the highest high quality of care and finest affected person outcomes. We respect the CMMI’s recommendation and steering all through the event of the mannequin, and are assured that we will work collectively to maneuver away from the restrictions and instability of conventional fee-for-service Medicare funds.”
The CMS Innovation Middle report back to Congress describes the availability of radiation remedy companies, why Medicare beneficiaries might have radiation remedy companies and the way Medicare pays for these companies. The report additionally describes a number of APM design issues, together with the kind of various cost mannequin; how the mannequin is anticipated to lead to medical follow transformation; the rationale for such a mannequin; the potential scale; its alignment with different initiatives; how the mannequin might measure improved medical high quality and affected person expertise; and the way readily suppliers might take part. The report additionally notes that the mannequin might additionally handle lots of the challenges with the present cost methods, doubtlessly producing extra year-to-year stability in radiation remedy funds.
Every year, 1.6 million Individuals are identified with most cancers, and about two-thirds-;a couple of million patients-;might be handled with radiation remedy to remedy or palliate their illness. To higher serve this complicated affected person inhabitants and have a significant and viable alternative to take part in cost reform as envisioned beneath the Medicare Entry and CHIP Reauthorization Act (MACRA), ASTRO labored with the radiation oncology group, together with representatives from freestanding facilities and hospital-based practices to develop an APM that meets the necessities for an Superior APM beneath MACRA.
The RO-APM incentivizes physicians to imagine accountability for controlling the entire price of spending associated to the situation. The RO-APM applies to main illness websites handled with radiation remedy, creating an episode-based cost that begins with medical remedy planning and concludes 90 days after the final radiation remedy. All through the method, healthcare members should adhere to nationally accepted medical remedy pointers and different high quality enchancment necessities. An outline of the mannequin is on the market on ASTRO’s web site.
ASTRO stays grateful to radiation oncology’s Congressional champions for his or her management on PAMPA and ongoing dedication to defending entry to radiation remedy for most cancers sufferers.