The American Society for Radiation Oncology (ASTRO) is urging the Centers for Medicare and Medicaid Services (CMS) to reconsider policy changes related to the 2022 physician fee schedule and the radiation oncology value-based care model.
ASTRO, which has more than 10,000 members, argues in letters to CMS that the policies will result in $300 million in cuts to cancer care: $140 million in cuts due to several policy changes in the 2022 Medicare Physician Fee Schedule and cuts of $160 million over five years under the mandatory Radiation Oncology Model (RO Model).
“This double hit will be devastating to our patients and radiation oncology teams, endanger patient access to life-saving treatment and threaten the viability of clinics still reeling from the COVID-19 pandemic,” wrote Thomas J. Eichler, M.D., chair of the ASTRO board of directors, in a statement. “Payment rates for some radiation treatments for breast and prostate cancer will drop by about 13 percent, for example, and by more than 22 percent for advanced lung cancer treatment.
ASTRO officials describe themselves as “confused and disappointed” that these proposed policies stand in such sharp contrast to President Biden's goals to 'end cancer as we know it' and advance health equity. They say the cuts will jeopardize patients' ability to get state-of-the-art cancer care close to home, with practices treating underserved populations hit hardest by the cuts. Patients in rural areas, risk losing access to cancer treatment in their communities, forcing long and expensive travel to receive care. And this comes at a time when cancer incidence rates are rising due to screening delays related to COVID-19, ASTRO says.
ASTRO recommends that radiation therapy cancer treatments should be held harmless from payment cuts due to the fee schedule's clinical labor pricing update. “We also are asking that the RO Model's discount factors be reduced to 3 percent to safeguard access to care for patients at the 950 hospitals and community-based clinics required to participate in the model, while ensuring Medicare achieves a reasonable level of savings,” Eichler wrote.
ASTRO calls it reckless for CMS to propose such a severe decline in reimbursement, particularly during a public health emergency. If CMS does not reverse course, ASTRO will ask Congress to intervene via legislation this year.
