CMS proposes indefinite delay for Radiation Oncology model already postponed by Congress

The Biden administration has moved to delay indefinitely implementing the controversial radiation oncology payment model in response to two recent delays passed by Congress. 

The Centers for Medicare & Medicaid Services (CMS) published a proposed rule Wednesday that said the indefinite delay will free up resources for other alternative payment models. The delay will also enable participants to pause any efforts to get ready for the model. 

The radiation oncology mandatory payment model is intended to reimburse oncology practices and hospital outpatient sites for total episodes of care and will make site-neutral payments for certain radiation therapies. 

But the model has generated major pushback from the oncology industry. The advocacy group Community Oncology Alliance said last August the mandatory model’s cuts will hurt oncology practices already under strain from the pandemic. 

The alliance had asked the model to be pushed back to 2023 and the cuts to be stopped. Congress agreed and passed legislation back in December to delay the start date from Jan. 1, 2022, to 2023. 

If the proposed rule is finalized, the model would be on hold for an indeterminate period of time. 

The delays from Congress played a major part in CMS’ decision.

“There is a substantial cost to continue funding preparation for implementation of the [Radiation Oncology] Model in 2023,” the proposed 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 and participant-specific payment amounts, among a number of other activities.”

CMS added that devoting funding to the model, which could be delayed again, could take away resources from other payment models. 

The delay is intended to help model participants which have invested funding to prepare for the model. 

“Given multiple delays and uncertainty about the timing of the [Radiation Oncology] Model indefinitely will give … participants the ability to pause their efforts to prepare for implementation of the [Radiation Oncology] model,” the rule said. 

CMS is taking comments on the delay, any amendments to the model’s payment methodology and other aspects of the design.

The decision drew plaudits from some oncology groups.

The American Society of Radiation Oncology hopes that CMS "makes the adjustments recommended by Congress and the broad coalition of stakeholders within the radiation oncology community as we remain concerned that the model in its current form is too punitive for clinics," said Laura Dawson, chair of ASTRO's board of directors, in a statement.