The Biden administration has finalized a rule that indefinitely delays the controversial radiation oncology payment model, which generated significant pushback from providers.
The Centers for Medicare & Medicaid Services (CMS) issued a final rule Thursday surrounding the payment model that intended to reimburse oncology practices and outpatient sites for a total episode of care. It would also develop site-neutral payments for certain radiation therapies.
CMS was dismayed that Congress has delayed the start date for the payment model twice, with the latest to Jan. 1, 2023. However, there remained uncertainty over whether lawmakers would again pass a delay. CMS was concerned about still devoting resources to keep the model going.
“There is a substantial cost to continue funding preparation for implementation,” the final rule said. “For example, funding is needed for CMS to prepare for participant onboarding, claims systems changes and updates to the data used in the model’s design.”
CMS added that the cost could take resources away from the development of other alternative payment models.
Provider groups cheered the decision to finalize the delay, noting that the model would lead to a drop in Medicare payments.
“Fair and stable Medicare payments are essential to support modern cancer care, especially as clinics face inflation costs,” said Laura Dawson, a member of the board of directors for the American Society for Radiation Oncology, in a statement. “We are optimistic that CMS will work more closely with the radiation oncology community on a reformed push for episodic payments.”