On July 18, 2019, the Centers for Medicare and Medicaid Services (CMS) proposed a payment model that would make prospective episode-based payment for a list of specified professional and technical radiation therapy (RT) services furnished during a 90-day episode to Medicare fee-for-service (FFS) beneficiaries diagnosed with one of 17 cancer types. This issue brief - the third in our series of "Radiation Oncology Episodes of Care"- shows that the newly proposed CMS payment model may present savings opportunities for radiation therapy providers.
CMS proposed a prospective payment model that would pay participating hospital outpatient departments (HOPD) providers and freestanding radiation therapy centers for radiation therapy (RT) episode-based payment for a list of specified professional and technical RT services furnished during a 90-day episode to Medicare fee-for-service (FFS) beneficiaries diagnosed with one of 17 cancer types. Providers will be paid a single rate for each specific cancer type regardless of the treatment modality (i.e., stereotactic radiosurgery, intensity-modulated radiotherapy, conventional external beam, intraoperative radiotherapy, proton beam therapy, or brachytherapy) selected for the patient. Technical component providers that will be subjected to the Radiation Oncology (RO) payment model will need to determine how to achieve a 5-percent savings, which is CMS discount from average historical spending. One option will be to assess the clinical appropriateness and cost effectiveness of the treatment modality used during the episode. This blog is the second in the multi-series of blogs titled "Radiation Oncology Episodes of Care" and examines the cost differences across the various treatment modality options and their impact on episode spending.