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Congress freezes radiation treatment payment rates for free-standing clinics through 2019

por Lauren Dubinsky, Senior Reporter | February 14, 2018
Insurance Rad Oncology Radiation Therapy
ASTRO applauds
On Friday, Congress passed bipartisan legislation that froze reimbursement rates for certain radiation oncology services at free-standing clinics through the end of next year.

“Stabilizing payment rates for another year is an important step, as ASTRO works with CMS to implement an alternative payment model for radiation oncology,” Dr. Brian Kavanagh, chair of the American Society for Radiation Oncology, told HCB News.

The association rigorously lobbied for Congress to pass the bill, and led stakeholders in the radiation oncology field to secure the one-year freeze. The bill has been passed by both the House and Senate and awaits the president’s signature.

The Patient Access to Medicare Protection Act (PAMPA) of 2015 froze the payment rates for radiation treatment delivery and image guidance outside of hospital-based departments at 2016 levels for 2017 and 2018.

Kavanagh testified to Congress in November 2017 — stating that ASTRO is worried that if PAMPA expires and there isn’t a plan for stable payments and an alternative payment model, it could jeopardize the viability of many cancer centers. PAMPA was set to expire on December 31, but this new legislation extends it through December 31, 2019.

“Lingering reimbursement uncertainty makes it challenging for clinics to make decisions about things such as updating their treatment technology, staff hirings and other important, practical operational considerations,” said Kavanagh.

When asked what the payment cut would have been if the legislation wasn’t passed, he explained that the exact value is not known because CMS has not yet proposed rates for 2019.

“Radiation oncology clinics have sustained cuts in the past, including a cumulative 20 percent cut in the eight years before PAMPA's passage, and we have concerns that these cuts could be renewed,” he added. “Implementing payment stability helps create a path to value-based care through an advanced APM for radiation oncology.”

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