Bottom line: Last week, more than 100 members of Congress joined in a bipartisan letter to Speaker McCarthy and Leader Jeffries emphasizing the urgent need to establish a stable Medicare payment system to appropriately pay for quality care.

Background: In 2015, the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law. It replaced the sustainable growth rate (SGR) formula with the Quality Payment Program, consisting of a new Merit-Based Incentive Payment System (MIPS) and processes to adopt Advanced Alternative Payment Models (APMs). MACRA shifted Medicare’s approach to physician payment: paying providers based on quality, value and the results of care delivered rather than the number of services provided.

Logistical challenges have plagued MACRA since its inception. Opportunities have been limited for physicians to fully participate in value-based payment via Advanced APMs and the MIPS program has become an administrative burden for many providers. Additionally, payment for care delivered remains tied to the existing Medicare Physician Fee Schedule (MPFS). Released each year by the Centers for Medicare and Medicaid Services (CMS), fee schedule updates have resulted in a 25% decline in reimbursement for radiation oncology services since 2013. Furthermore, though physician practice costs rise with inflation, the fee schedule is not adjusted accordingly. These factors are adding to physicians’ financial instability and jeopardizing patients’ access to care.

Why it matters: Years of continued MPFS cuts jeopardize cancer patients’ access to care. These continued cuts underscore the need for ASTRO’s proposed Radiation Oncology Case Rate (ROCR) program, which would secure stable payment rates, improve upon what is already top-quality car, and reduce patient disparities.