Radiation oncologists and members of the American Society for Radiation Oncology (ASTRO) gathered on Capitol Hill this week to request congressional support for policies designed to protect access for cancer patients to high-quality, value-based care.

Meeting with policymakers on ASTRO Advocacy Day, the clinicians brought up a number of legislative priorities that they claim require greater attention, protection and improvement.

One such topic was the current payment model exercised in healthcare settings for value-based care, which has garnered much concern due to the upcoming expiration of a payment freeze by the Centers for Medicare and Medicaid Services that prevents cuts to reimbursements through the end of 2019.

"Policymakers increasingly recognize the potential advantages of episode-based payment models relative to fee-for-service structures, but radiation oncologists are not yet able to fully participate in this transition to value-based health care," Dr. Paul Harari, chair of the ASTRO board of directors, told HCB News. "For Medicare patients the only quality payment program available now for radiation oncologists is the Merit-based Incentive Payment System (MIPS), and ASTRO members feel that the current reporting burdens of MIPS leads to inefficiencies without improving quality of care for patients."

Harari and his fellow members instead suggested the implementation of an episode-based APM for radiation oncology that would drive adherence to clinical guidelines by incentivizing radiation oncologists to abide by guideline-concordant care episodes, thereby improving cancer patient care and stabilizing reimbursements, especially for providers of Medicare, of which most American patients are beneficiaries. The idea for such a model stems from a proposal made in 2017 to incentivize radiation oncologists to abide by nationally respected guidelines for treating five of the most common cancers with radiotherapy. They include breast, lung, prostate, colorectal, and head and neck.

They also called for an end to unnecessary prior authorizations, seeing them as hindrances that prevent radiation oncologists from providing patients with the best course of action, despite being held accountable for the outcomes of treatments. A recent survey completed by ASTRO members found that 93 percent of radiation oncologists found their patients experienced delays in treatment due to prior authorization, with 31 percent experiencing delays longer than five days, the equivalent of a full week of standard radiation treatment. The main causes were found to be demands on radiation oncologists to generate multiple treatment plans; peer-to-peer reviews by non-experts in radiation oncology (including non-doctors sometimes); and the appeals process to overturn a substantial majority of denials for radiation therapy.

In addition to stress and anxiety, such delays increase risk of death by 1.2 to 3.2 percent per week, according to ASTRO, which proposes that CMS require Medicare Advantage to align prior authorization requirements with the Consensus Statement on Improving the Prior Authorization Process.

Another proposal was an increase of at least $2.5 billion in federal funding for cancer medical research performed by the National Institutes of Health, and at least $378 million for the National Cancer Institute, for the financial year 2020. It asserts that such investments provide significant advances in radiation oncology and help decrease cancer-related deaths, the last recording of which, from 2016, puts this rate at 27 percent lower than its status 25 years ago, and has resulted in the aversion of 2.4 million cancer-related deaths.

The last of its proposals revolves around the preservation of access to radioactive source-based technology in healthcare, with advocates arguing that attempts to limit such access prevent patients from receiving lifesaving radiotherapy treatments. "Misinformation can lead to fear-driven policies that could reduce access to radiation therapy," said Harari. "Additionally, pressures to abandon these technologies in favor of so-called replacement technologies fail to consider that cancer cure rates can be directly compromised and in most cases there are no equivalent technologies."