Members of Congress from both sides of the aisle issued a series of oversight letters to the Centers for Medicare and Medicaid Services (CMS) in recent months to urge the Agency to adjust its proposed radiation oncology advanced alternative payment model (RO Model). CMS is expected to issue its final determination before the end of 2019.
Radiation oncology congressional champions Senators Richard Burr (R-N.C.) and Debbie Stabenow (D-Mich.) and Representatives Michael Burgess (R-Texas), Brian Higgins (D-N.Y.), George Holding (R-N.C.), Devin Nunes (R-Calif.), Mike Simpson (R-Idaho) and Paul Tonko (D-N.Y.) were among those who wrote to CMS Administrator Seema Verma to advocate that the RO Model be revised prior to it being finalized in order to protect cancer patients' access to life-saving radiation treatments. Their letters echo key areas of concern identified by physicians, patients and stakeholders from the radiation oncology community.
In their letters, congressional leaders focused on the scope, implementation and payment structure of the proposed RO Model. The letters specifically expressed concern about the mandate that requires a high percentage of radiation oncology practices to participate; the planned January 1, 2020 start date; and that the proposed bundled payment rates fail to account properly for community-based clinic costs and curative treatments, as well as several other priorities. In addition, the letters highlighted the misalignment between significant “discount factor” payment cuts for participants without adequate incentive payments provided for under existing Medicare law.
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Senators Burr (R-N.C.) and Stabenow (D-Mich.)
The Senate Finance Committee’s longstanding supporters of radiation oncology wrote, “We believe that the current proposal does not fully balance the incentive to participate with the decrease in payment rate, potentially jeopardizing the availability of radiation therapy services for seniors.” They added, “We urge CMS to address the above concerns to ensure that the model achieves what we all set out to accomplish – higher quality, more efficient, and effective care for patients.” Read the full letter from Sen. Burr and Sen. Stabenow.
Representatives Burgess (R-Texas) and Nunes (R-Calif.)
The leading Republicans on the health subcommittees of the House Ways and Means and Energy and Commerce committees reminded CMS of the overall purpose of this effort. “The goal of improving payment stability and moving to value-based payment for radiation oncology began with a partnership among CMS, the radiation oncology community, and Congress. We urge you to continue to honor the spirit of this partnership by working in a transparent manner to address the concerns voiced by the radiation oncology community,” they wrote. They also addressed required participation, noting “As a general principle and patient safeguard, we believe that the Center for Medicare and Medicaid Innovation (CMMI) should begin testing with a smaller scope. Similar to prior CMMI models, CMS should first allow for a period of voluntary participation in order to test the Model design.” Read the letter from Rep. Burgess and Rep. Nunes.