RFS news highlights resources, issues, and news relevant to in-training members of the ACR. If you have a topic idea or would like to contribute to the blog, please email RFS Secretary Patricia Balthazar, MD.
RO Corner: New APM Proposed for Radiation Oncology
Several weeks ago, a new radiation oncology-specific alternative payment model (APM) was introduced by the Centers for Medicare and Medicaid Services Innovation Center (CMMI). This new payment model has the goal of supporting value-based care to improve outcomes for cancer patients. The American Society for Radiation Oncology (ASTRO) has worked closely for several years with the Center for Medicare and Medicaid Services (CMS) in the development of the Radiation Oncology Alternative Payment Model (RO-APM).
The goal of this model is to shift away from volume and towards value in patient care. The current fee-for-service based payment system does not incentivize the optimal or most cost-effective treatments for patients necessarily. Particularly in an era in which shorter radiation treatments for cancer sites such as breast and prostate cancer have a growing body of evidence that shorter treatments are equally efficacious and less burdensome for patients, it is important to have a payment model in place that incentivizes the best treatments for patients.
The nuts and bolts of the RO-APM include a few key details. The RO-APM will apply to both hospital-based and freestanding centers. It will consist of a prospective payment for a 90-day episode of care, with separate payments for the professional and technical charges. This model will apply for 17 different cancer types including the most common cancers (prostate, breast, lung, etc.). This essentially represents a shift to bundled payments for a set of services, such as has been done in other specialties such as orthopaedic surgery. The implementation will be required for certain radiation oncology centers within randomly selected areas in the country. The model will be tested for five years – from 2020 until the end of 2024 – to determine if the RO-APM can reduce Medicare expenditures and preserve or enhance quality of care for patients.
There are a number of resources where you can learn more about the RO-APM, including:
• The ASTRO Radiation Oncology Press Kit
• Official statement from Paul Harari, MD, FASTRO, Chair of the ASTRO Board of Directors
• RO-APM Infographic
• Official Proposed Rule from CMS
• Overview of the RO-APM from CMS
• CMS Factsheet on RO-APM
Anna Laucis, MD, MPhil, is a resident at the University of Michigan.