Last month, the Centers for Medicare & Medicaid Services (CMS) announced a proposal for a new mandatory radiation oncology (RO) bundled payment model to begin in early 2020. As MedBen Analytics reported after the announcement, the 5-year model would use Medicare data to assess patient outcomes for 17 types of cancer.
Like the current Comprehensive Care for Joint Replacement (CJR) Model, radiation oncology providers would be randomly selected to participate in the RO Model, and payments would be linked to quality metrics rather than fee-for-service. But Health Affairs notes that the RO Model does depart from earlier mandatory bundled payment programs in three distinct ways:
- CMS intends to pay RO Model participants on a prospective basis using separate payments for professional and technical components of care.
- CMS proposes site neutral payments, using an episode-pricing model that reimburses participants based on hospital-outpatient department rates, irrespective of site of care.
- Randomized participation in the CJR Model was limited to selected metropolitan statistical areas, while the proposed RO Model would also select providers from non-rural “micropolitan” areas.
Despite these differences, the CJR and RO Models will share an important attribute: Provider payments will be directly impacted by quality and reporting.
CMS has posted the proposed RO Model rule on the Federal Register. Those who wish to submit a formal comment on the rule may do so until September 16, 2019, at 5 p.m. ET.
As additional information becomes available about the RO Model, we’ll report it in future editions of MedBen Analytics insight. In the meantime, providers with questions about any aspect of bundled payment programs are welcome to contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or ccoventry@medben.com.