CMS delays mandatory payment model that would reduce access for critically ill cancer patients

November 03, 2020
Area(s) of Interest: Advocacy 

The Centers for Medicare and Medicaid Services (CMS) has delayed implementation of the mandatory Radiation Oncology Alternative Payment Model (APM) until July 1, 2021. According to CMS, the decision to delay the policy was based on feedback it received from the California Medical Association (CMA) and other stakeholders about the challenges of implementing a complex new model during a pandemic.

The final rule estimates cuts of 6% to participating group practices and 4.7% cuts to hospital outpatient departments, with no apparent upside potential for required participants. These proposed cuts are completely inconsistent with every other alternative payment model adopted to date. When coupled with the 11% general Medicare payment cut radiation oncologists  are facing in 2021, the radiation oncology payment model threatens to substantially reduce access to care for critically ill cancer patients in California.

Physicians continue to struggle to maintain the viability of their practices in all specialties across California at a time when we need physicians more than ever. CMA believes it is unreasonable to expect physicians to comply with a complex new payment model with just 90 days notice during a pandemic. CMA is also urging CMS to revise the model so that it is voluntary and the projected payment cuts are mitigated.        

California radiation oncologists are truly concerned about their ability to continue to provide high quality cancer care, particularly in some of California’s rural communities where there are already shortages of physicians.

CMA has urged CMS to delay the radiation oncology model for one year or at least until the COVID-19 public health emergency is over. Delaying the model and working to make improvements will help radiation oncologists successfully transition to value based care while protecting access to live-saving medical treatment for patients. 

Click here to see CMA’s letter.


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