The ROCR Act: Past, Present and Future

As 2024 winds down, this is a good time to take stock of radiation oncology’s efforts to advance Medicare payment reform legislation, known as the Radiation Oncology Case Rate (ROCR) Value Based Program Act (S. 4330/HR 8404).

Representing ASTRO’s most significant legislative initiative, the ROCR Act was introduced by a bipartisan group of leading health policy lawmakers in May, just days before nearly 100 ASTRO advocates, including about 30 residents, came to Washington, DC, for Advocacy Day. The energy of the event was unmatched, as participants met with more than 100 congressional offices urging cosponsorship of the bipartisan bills.

In July, the ROCR Act received a huge boost, as more than 60 organizations signed a letter to House and Senate leadership urging passage of the ROCR Act. The diversity of the list of supporters is truly striking, with freestanding centers – big and small – and hospitals – academic and community – all represented. When the American College of Radiation Oncology endorsed the ROCR Act in August, it meant that all four radiation oncology specialty societies backed the bill, with The American College of Radiology and Association for Clinical Oncology already on board.

At the ASTRO Annual Meeting in late September, even more groups signed on in support of the ROCR Act, and excited talk filled the DC Convention Center. During the ASTRO Business Meeting, ROCR Act champion Sen. Thom Tillis (R-NC) addressed attendees via video, sharing why he is leading efforts in the Senate “to provide transformative Medicare payment reform for cost-effective and valuable radiation therapy.” Sen. Tillis’ senior health care aide Garrett Daniel joined the meeting in person, discussing what needs to happen for the ROCR Act to advance in a divided Congress with few legislative days remaining in 2024.

That brings us to today, when ASTRO and its ROCR Act partners are working to navigate a complex, post-election legislative environment to pass the bill this year. Congress has a deadline of December 20 to fund the government, which could be a vehicle to pass other legislation — including legislation to block additional Medicare physician payment cuts — but the size and contours of such a bill are still unclear given the transition to the new Congress and Administration.

While the ROCR Act has a lot going for it, including a bipartisan Senate bill with two cosponsors and 10 bipartisan cosponsors on the House bill, the legislation faces challenges beyond the uncertain environment. For instance, a backlogged Congressional Budget Office (CBO) has not yet responded to a House Budget Committee request for a “score” or savings estimate on the bill. Confirming a modest level of savings for the ROCR Act is essential for passage and, like hundreds of other pending health bills, the ROCR Act is stuck in a long queue waiting for CBO’s analysis.

In addition, some radiation therapy manufacturers have expressed concern about technology provisions in the ROCR Act, including treatment of adaptive radiation therapy. ASTRO is open to changes to address these concerns and has had numerous discussions with the manufacturing community but has not yet reached agreement on a solution.

Given these issues, ASTRO is preparing for the possibility that the ROCR Act may need to be reintroduced in the new Congress next year. This is no surprise and not unusual, as it often takes years for legislation to earn the support and overcome the tangled web of procedural and political hurdles to become law. According to GovTrack.us, 18,317 bills and resolutions were introduced in the 118th Congress thus far, and only 320 were enacted into law. Many of these bills will be reintroduced in the 119th Congress, and if the ROCR Act is one, ASTRO and its partners are ready to move forward.

Reintroduction in the 119th Congress gives ASTRO more time and opportunities to build a strong lineup of bipartisan cosponsors that serve on the key health care committees. It also provides another chance to secure a favorable CBO savings estimate, as well as a more thorough vetting by the key committees, perhaps as part of a hearing. Discussions around Medicare payment reform picked up late in 2024 and are expected to accelerate in 2025, perhaps providing a more favorable environment for the ROCR Act to move.

To advance the ROCR Act today and tomorrow, the advocacy fundamentals for ASTRO members remain the same:

• Reach out to ASTRO staff to learn more about the bill and consider adding your practice as a supporter.
• Use ASTRO’s grassroots system to quickly and easily contact your member of Congress or work with ASTRO staff to email the office’s health care aide.
• Join us for the 20th Anniversary ASTRO Advocacy Day on May 19-20 in Washington, DC, where the ROCR Act will again take center stage.
• Host a clinic tour for your member of Congress, prepped with ROCR Act talking points from ASTRO staff.

These are just a few of the many ways ASTRO members can engage in advocacy in support of the ROCR Act payment reforms needed to secure the future of the specialty.