Health Affairs: Advancing Bundled Payments Through Radiation Oncology Episodes

By Amol Navathe, Justin Bekelman, and Joshua Liao On July 10, 2019, the Centers for Medicare and Medicaid Services (CMS) announced a proposal to test bundled payments for radiation oncology services for 17 types of cancer (see exhibit 1). Although it shares features with existing bundled payment programs, the Radiation Oncology (RO) Model is positioned to launch CMS payment policy forward with novel features aimed at curbing known inefficiencies in spending on radiation therapy. As proposed, the RO Model shares or extends features used in preceding bundled payment programs. Like those in the ongoing Oncology Care Model (OCM), episodes in the RO Model would be triggered by initiation of therapeutic service—in this case, radiation therapy. Like the Comprehensive Care for Joint Replacement (CJR) Model, the RO Model requires participation based on location in randomly selected geographic markets. The RO Model also ensures that CMS achieves savings by setting a discount factor (that is, the percentage by which CMS reduces payment for an episode, relative to traditional fee-for-service amounts) and sets payment based on national base rates adjusted for each participant’s geographic location, patient panel, and historical treatment patterns.” Read more at Health Affairs.