Congress Must Protect Patient Access to Radiation Oncology

November 23, 2021

The Association for Clinical Oncology (ASCO), along with nearly 30 other stakeholder groups, sent a letter to congressional leadership urging lawmakers in both chambers to protect patient access to potentially life-saving cancer care by passing legislation to prevent massive cuts to Medicare reimbursement for radiation oncology.

The Centers for Medicare & Medicaid Services recently finalized an approximately 8% (or nearly $150 million) cut to radiation oncology reimbursement under the Medicare physician fee schedule (PFS), in addition to a $150 million cut under the Radiation Oncology (RO) Model. These cuts come as the COVID-19 pandemic has caused delays in diagnosis and surgeries for many patients, which means that more patients are likely to present with more advanced stage cancer, requiring more expensive treatment.

In October of 2021, more than 100 bipartisan Members of Congress signed three letters to the Biden Administration objecting to the excessive reimbursement cuts for radiation therapy under the PFS and the RO Model.

ASCO and the other stakeholder groups now ask Congress to respond to these concerns and pass legislation by the end of the year to:

  • Freeze most radiation therapy payments under PFS for 5 years at 2021 levels
  • Reduce the RO Model discount factors to 3%
  • Restore the 5% Alternative Payment Model (APM) incentive payment to eligible freestanding centers

Freezing fee schedule payment rates would stabilize reimbursement for community-based practices, allowing them to maintain services. Additionally, a payment freeze will allow for a clean evaluation of the RO Model to better inform future value-based payment models. Reducing the RO Model discount factors to 3% will more evenly distribute the payment impact across Model participants, while still saving Medicare approximately $100 million over 5 years. Finally, restoring the 5% APM incentive payment would ensure the RO Model adheres to requirements of the Medicare Access and CHIP Reauthorization Act of 2015.

Read the full letter.

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