Health

Oncology group presses CMS to roll back payment cuts, changes to controversial payment model

A top oncology group is calling on the Biden administration to halt a 22% reduction in payments for high-grade radiation treatments and $160 million in cuts proposed for a mandatory payment model.

The American Society for Radiation Oncology (ASTRO) released a statement Tuesday decrying the proposals in the Physician Fee Schedule released last week and changes to the Radiation Oncology Model outlined in the Hospital Outpatient Prospective Payment System rule released on Monday. The group said that the cuts are harmful for radiation oncologists especially in light of the pandemic.

“Access to life-saving cancer treatments will suffer, and the viability of clinics already reeling from the pandemic will be at considerable risk if these proposals are finalized,” said Thomas J. Eichler, chair of ASTRO, in a statement Tuesday.

The group warned about a series of changes to the payment methodology associated with the model, which aims to reimburse hospital outpatient sites and physician group practices that include freestanding radiation therapy centers for total episodes of care. The model will make site-neutral, prospective payments for certain radiation therapy services and treatments.

The payments are split into professional and technical components. The professional payment is intended to reimburse providers for the services made by a physician, and the technical payment is for those not furnished by a physician.

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But ASTRO charged that the Centers for Medicare & Medicaid Services has set the payment methodology to be too punitive.

The agency is proposing to set the discount factors for model participants at 3.5% for the professional component and 4.5% for the technical component. The model originally had the discount factor of 3.57% for professionals and 4.75% for the technical component.

The discount factor is the percentage where CMS “reduces an episode payment amount, reserves savings for Medicare and reduces beneficiary cost-sharing,” according to a fact sheet on the model.

ASTRO believes the discount factor is set too high, especially in context with other models.

“Other payment models that [the Center for Medicare & Medicaid Innovation] released has included risk factors or discounts that are significantly less,” said Anne Hubbard, director of health policy for ASTRO, in an interview with Fierce Healthcare.

Another issue is that the model is mandatory and “has never been tested,” Hubbard added. “Practices automatically have payments withheld, 3% on practice side and 1% on technical side associated with quality measure performance.”

The Physician Fee Schedule also called for a cut to high-value radiation treatments by as much as 22%, ASTRO said.

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Hubbard noted that the cuts are coming at a point when radiation oncology services are down 8% due to the pandemic.

“You are talking about some pretty serious cuts on practices that have been through significant reductions resulting from a public health emergency that everybody is struggling through,” she said.

ASTRO has been a staunch opponent of the model, which Hubbard said doesn’t fully comprehend the costs that radiation oncologists face.

“Our practices have high capital costs,” Hubbard said. “This model because of these cuts doesn’t recognize that those capital costs are not variable. They are there regardless of patient volumes or what have you. There is no way to recognize the fact that for some specialties there is limited amount of variable cost to decrease to generate savings for Medicare.”

Congress in a spending bill last year pushed back the start date of the model from July 1, 2021, to Jan. 1, 2022.

Hubbard said that the organization is considering another push to CMS and Congress for modifications to the model.

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