Health Law Matters

Opposition Mounts to Prospective Payments for Radiation Oncology

The Week In Health Law

  • Stakeholders such as the American Hospital Association (“AHA”) are voicing opposition to a proposal from the Centers for Medicare and Medicaid Services (“CMS”) mandating prospective payments for certain radiation oncology treatments. Last July, CMS proposed to implement a model that would reimburse a prospective, site-neutral payment to cover 90-day radiotherapy episodes for 17 types of cancer.  The model would require physician group practices, hospital outpatient departments, and freestanding radiation therapy centers in randomly selected areas to participate and report certain quality, patient experience, and clinical data to CMS over the course of a five-year period.
  • AHA and other organizations have submitted multiple comment letters to CMS regarding the proposal. AHA is objecting to the mandatory nature of participation, stating in its letter to CMS that providers “should not be required to participate in such a complicated program … if they do not believe it will benefit the patients they serve. Moreover, other providers that may have the systems in place to excel under this new model could be excluded based on geographic location.”
  • The American Society for Radiation Oncology (“ASTRO”) objected to the fact that the proposal requires providers to immediately assume financial risk. ASTRO urged CMS to make the model voluntary with little to no risk: “Transition to a risk-based model with opt-in and opt-out provisions can then take place over a period of time.This approach is similar to how the Agency instituted the Comprehensive Joint Replacement model, which allowed for a one-year transition without any downside risk, as well as the Oncology Care Model….”

More trending Health Law topics this week:

  • Court Overturns CMS Expansion of Site-Neutral Payments

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James (Jim) A. Dietz is a Member at FBT who provides an array of legal services to hospitals, physicians, long-term care providers, diagnostic facilities, and others across the spectrum of patient care.