How ROCR Will Impact Early Career Radiation Oncologists
By Anna M. Brown, MD, MPhil, Chair of the Community Building Subcommittee
Payment reform has long been on the horizon for radiation oncologists. Years ago, the Centers for Medicare and Medicaid Services (CMS) had been in discussions about an Alternative Payment Model (APM) for the field of radiation oncology. This would have been a mandatory program with some exemptions and would have monumentally affected the way that radiation oncology services were reimbursed. That effort, the RO-APM, ultimately was delayed and then delayed indefinitely in the face of criticism from ASTRO and other key stakeholders.
In the past year or so, ASTRO has worked tirelessly to put together a legislative effort that would transition radiation oncology payment away from a per-fraction model (the current state) and toward a per-patient model (case rate payment model), which many believe is more sustainable in the long run with overwhelming evidence supporting hypofractionation for many disease sites, which means fewer fractions per treatment. Our field can no longer afford to let payments dwindle as practice patterns change, and currently the financial incentives are not driving us toward evidence-based hypofractionation but away from it. Additionally, there is a growing tension, particularly in the era of increasing influence from corporate medicine, between evidence-based medicine and maximizing reimbursement for the services given. While some evidence-based practices like IMRT and SBRT have higher reimbursement rates, other evidence-supported practices like hypofractionation (which is quite simply fewer fractions per treatment course) reimburse at a proportionally lower rate than the standard/conventional fractionation rate, sometimes substantially so. This has a domino effect on patient care and convenience, and may worsen health disparities, particularly in rural areas.
Moreover, the economic climate has bleak prospects if our field doesn’t take an aggressive approach, as the Medicare Physician Fee Schedule (MPFS) has heralded in significant annual cuts to physician budgets in all specialties, and highly technical fields like radiation oncology have been among the most affected by these cuts. Thus, it is imperative to be proactive about this issue through payment reform. One such effort is the Radiation Oncology Case Rate Program (ROCR) legislative bill which has been introduced in both the Senate and the House and supported by more than 70 organizations throughout the cancer community. Although it will take significant effort to garner the attention of this Congress during a pivotal election year, even in the lame duck session, ROCR represents our best way out of an otherwise dire economic situation for the field of radiation oncology. A number of resources are available through ASTRO to learn more about ROCR, calculate the estimated economic impact on individual practices, and also advocate to your local representatives to support this effort, as it is the best way to help preserve our ability to continue providing evidence-based radiation oncology to our patients in all practice settings. Learn more about ROCR. Get involved by sending a letter to your local member of Congress member to support ROCR.
