Healthcare Regulatory Check-Up April 2022: CMS Regulatory Developments
CMS RADIATION ONCOLOGY MODEL DELAYED
CMS decided to delay indefinitely the start date of the Radiation Oncology (RO) Model. The start date will be determined through future rulemaking. CMS also decided to modify the definition of the model performance period to provide that its start and end dates will be established in future rulemaking.
The RO Model would allow CMS to test whether making site-neutral, prospective, episode-based payments to hospital outpatient departments, group practices and freestanding radiation therapy centers would preserve or enhance quality of care while reducing or maintaining spending. Critics are concerned that the model in its current form is punitive, and that while value-based payments are generally supported, discount factors folded into the payment model could have a significant impact on realized revenue and would be a non-starter for the radiation oncology community.
The Protecting Medicare and American Farmers from Sequester Cuts Act, passed on December 10, 2021, included a provision prohibiting implementation of the RO Model prior to January 1, 2023. The start date had previously been delayed to January 1, 2022, as a result of the COVID-19 pandemic.
CMS intends to use the delay to modify the definition of the model performance period and to establish a start date. However, CMS is cognizant of the cost and funding necessary to prepare for participant onboarding, claims system changes, and updates to the data used in the RO Model design and participant-specific payment amounts. The indefinite pause allows the agency and RO Model participants and practices to cease preparatory activities.
Evie Atwater, Carole M. Becker, Kristina Dipano, Dexter Golinghorst, Adetoro Olugbemi also contributed to this article.