May 16, 2024

ACR-Supported Legislation to Reform Radiation Oncology Payment Introduced in Congress

The Radiation Oncology Case Rate (ROCR) Value-Based Program Act of 2024 (S. 4330 /H.R.8404) was introduced this week by U.S. Sen. Thomas Tillis (R-NC) and Reps. Brian Fitzpatrick (R-PA), Jimmy Panetta (D-CA), John Joyce, MD (R-PA) and Paul Tonko (D-NY). The legislation would increase patient access to care, improve the quality of cancer treatments, reduce disparities for rural and underserved patients, and lower patient costs while achieving significant savings for Medicare.

Radiation oncology experienced severe Medicare reimbursement cuts, exceeding 20% over the last 10 years. At the same time, radiation oncology practices continue to face rising costs as cutting-edge technology and skilled treatment teams get more expensive; this is not sustainable. The American Society for Radiation Oncology (ASTRO) and other organizations from the oncology community, including ACR, support S. 4330/H.R. 8404 to reform radiation oncology payment.

Radiation oncology is a highly cost-effective cancer treatment, yet Medicare spends less on radiation oncology treatments than it does on just three cancer drugs. While the Centers for Medicare and Medicaid Services (CMS) recognized and attempted to address these unique challenges with a proposed radiation oncology model (RO model), the model has failed to achieve value-based care goals due to excessive payment cuts and administrative burdens. CMS indefinitely delayed implementation of the RO model in August 2022. Learning from the RO model (S. 4330 /H.R. 8404) will enable advances for people with cancer.

The ROCR payment program would: change radiation oncology payment from per fraction to per patient; reverse decade-long declines in Medicare payments; and usher in a new era of stable payments, higher quality care, and reduced disparities.

For additional information, contact Christina Berry, Team Lead for Economic Policy.