ACRO Endorses Radiation Oncology Case Rate Legislation (S. 4330 / H.R. 8404)

FOR IMMEDIATE RELEASE

ACRO Endorses Radiation Oncology Case Rate Legislation (S. 4330 / H.R. 8404) As Part of Broader Effort to Remove High-Cost Equipment and Supplies from the Medicare Physician Fee Schedule

WASHINGTON, DC – [August 28, 2024] – Today, the American College of Radiation Oncology (ACRO) endorsed the Radiation Oncology Case Rate Value Based Program Act (S. 4330 / H.R. 8404). In December of 2023, ACRO joined with the American Society for Radiation Oncology (ASTRO) with the goal of reforming radiation oncology Medicare payments. ACRO believes this legislation is an important step forward towards this goal and as part of a broader effort to remove high-cost equipment and supplies from the Medicare Physician Fee Schedule (MPFS).

For years, ACRO has been aggressively advocating for reversal of ongoing Medicare cuts to radiation oncology and is proud to have led the effort to secure a freeze to radiation therapy cuts in the Patient Access and Medicare Protection Act of 2015 (PAMPA).

• PAMPA also included provisions requiring the Secretary of Health and Human Services to submit to Congress a “report on the development of an episodic alternative payment model for payment under the Medicare program .... for radiation therapy services.”
• This report ultimately led to the Center for Medicare and Medicaid Innovation (CMMI) proposing a radiation oncology case rate model in 2019. Although the overall structure of the CMMI model was promising, discounts contained within later versions of the model rendered it unacceptable to the broader radiation oncology community, particularly given more than 20% cuts that already had occurred to the specialty since 2006.

In contrast, while the Radiation Oncology Case Rate Value Based Program Act has not yet been scored by the Congressional Budget Office, it does not appear to contain certain problematic discounts and withholds even as it maintains much of the broad structure of CMMI’s proposed model.

Since the introduction of the Radiation Oncology Case Rate Value Based Program Act in the Congress a few months ago, ACRO has undertaken a broad outreach effort to its membership and industry stakeholders regarding the legislation. In light of this feedback, ACRO supports further perfection of the bill through the legislative process to address any remaining member and stakeholder concerns.

• ACRO believes the objective of the legislation is far preferable to today’s MPFS, which is so clearly unable to properly account for many procedures.
• Indeed, in 2024, according to Medicare’s own data, for at least 195 procedures covered in the MPFS – including radiation treatment delivery services – Medicare reimbursement no longer even meets the direct costs of providing such services, not to mention indirect costs or physician work.
• In 2025, under the 2025 MPFS Proposed Rule, this number of non-viable services in the MPFS will grow to at least 300, a 50% increase.

For these reasons, ACRO supports the continued refinement of the Radiation Oncology Case Rate Value Based Program Act and other efforts to remove high-cost equipment and supplies from the MPFS as part of broader MPFS reform. ACRO is committed to important advocacy initiatives to protect and enhance access to radiation therapy services for cancer patients of today and tomorrow.