Imagine a scenario where providing the best possible care for your patient threatens the financial viability of your clinic. Well, that’s exactly what radiation oncologists across the country are facing due to a broken payment system that stresses volume over value.
While that situation strikes fear into your heart, imagine technical payments for your services being slashed by more than 20%, while the costs of your expensive equipment and staff rise due to inflationary pressures. Picture patients with cancer from rural and underserved communities that receive a consult, treatment plan and simulation for radiation therapy, but then can’t afford the daily transportation to and from their treatments.
These nightmare scenarios are playing out in real time for radiation oncology care teams and their patients. But take heart, as there’s a reform plan to reverse these troubling trends. The American Society for Radiation Oncology (ASTRO) has proposed the Radiation Oncology Case Rate (ROCR) payment program that will upend the broken Medicare payment system for radiation therapy services.
ROCR’s goals are to increase access, enhance quality, reduce disparities and lower total costs by changing payment in radiation from per treatment to per patient. ROCR is a legislative initiative that’s on a roll, building momentum among stakeholders and on Capitol Hill to usher in a new era of stable payments, guideline-based care and reduced disparities.
Picture patients with cancer from rural and underserved communities that receive a consult, treatment plan and simulation for radiation therapy, but then can't afford the daily transportation to and from their treatments.
ROCR takes the good aspects of the Medicare-proposed Radiation Oncology (RO) Model, notably its bundled payment rates for 15 common cancers, and ditches the bad, including a complicated payment methodology that would drive down payment rates and excessive administrative and reporting requirements.
Perhaps ROCR’s most popular feature is an evidence-based approach to reducing disparities. ROCR’s Health Equity Achievement in Radiation Therapy (HEART) initiative identifies rural and underserved patients at risk of not initiating or completing their radiation treatments, then provides a transportation assistance payment to fill the gap. HEART builds on a successful NCI-funded prospective clinical trial that not only closed the disparity between Blacks and Whites in access to radiation treatments but also delivered a survival benefit.
In addition to supporting shorter radiation treatment regimens when appropriate, for instance in breast and prostate cancers, ROCR would also encourage practices to obtain practice accreditation — the gold standard for high quality care in radiation therapy. Unlike the meaningless Merit-Based Incentive Payment System requirements, more than 50% of radiation oncology practices already recognize the value of practice accreditation from ASTRO’s Accreditation Program for Excellence® (APEx), the ACR or the American College of Radiation Oncology (ACRO). ROCR rewards these practices and offers incentives for others to get accredited from any of the three bodies.
Radiation oncologists in both hospital and freestanding settings are already signing up to support advancing ROCR in Congress. ASTRO, ACR, ACRO and the Association for Clinical Oncology (ASCO) highlighted ROCR in a January 2024 joint statement committing to “a partnership with the goal of reforming radiation oncology Medicare payments to expand and enhance access to high quality care for people with cancer.” Critical groups such as the American Association of Physicists in Medicine, the American Association of Medical Dosimetrists and U.S. Oncology also are backing ROCR.
This support is essential, as introduction of legislation to advance ROCR is nearing. Early conversations with lawmakers have been positive, appreciating that the radiation oncology community is coming up with innovative solutions to health policy problems. There’s no denying the challenging environment on Capitol Hill, but ASTRO is confident that ROCR’s comprehensive approach to achieving cancer policy goals, while saving Medicare money, is on the path to success.
We urge radiation oncology practices to reach out to ASTRO and use tools on ASTRO.org to model performance under ROCR. The goal is for all members of the radiation oncology community to support ROCR with all their hearts, which is what it will take to get across the finish line in Congress.
According to an ASTRO analysis, the use of guideline-supported shorter treatment regimens has already reduced hospital technical payments by about $1,500 per patient, with further drops forecasted as more practices adopt these clinical best practices. This is no time for the faint of heart. Radiation oncology needs ROCR to fully realize its potential as a cornerstone for high-value, cost-effective cancer care.