On September 18, 2020, The Centers for Medicare and Medicaid Services (CMS) finalized the Radiation Oncology Bundled Payment Model and delayed implementation to July 2021. Through our access to Medicare claims data, Dobson | DaVanzo will be developing national and regional benchmarks to help providers assess their current performance and identify areas for potential savings under the new bundled payment model. We can help providers make use of their own CMS provided data by constructing episodes of care and dissecting their historical Medicare payments for various components of radiation therapy episodes as well as the utilization and costs of different treatment modalities.
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.