CMS rolling out mandatory cancer payment model

Written on Nov 15, 2018

The Center for Medicare and Medicaid Services (CMS) plans to unveil a mandatory Medicare payment model for cancer patients, and two new voluntary models for cardiac care in the coming weeks, said HHS Secretary Alex Azar. That means the Trump administration is reversing course from its prior stance that payment models, which put providers at risk of losing money if they don't lower costs of care, should be voluntary.

The new mandatory model will focus on radiation oncology.

Oncologists spoke out against the idea which could greatly impact one of the most expensive service lines in the health care industry.

Oncologists want the CMS to make participation voluntary, at least in the early years of the model.

HHS first revealed the need for a radiation oncology model in a report to Congress last year. In that document, it said that Medicare Part B payments for radiation treatment increased 216% between 2000 to 2010 because it's so expensive and because of the expected increase in use.

Demand for radiation therapy may increase 38% for seniors ages 65 and older from 282,000 in 2010 to 388,000 in 2020, according to the report.

Azar's remarks follow the unveiling of the administration's first mandatory model last week. That arrangement seeks to lower spending on drugs administered in doctors' offices and hospitals.

The two cardiac models currently in the works build upon those canceled by the Trump administration last year.

The CMS previously has acknowledged that some hospitals wanted the models to continue on a voluntary basis, as they had already invested resources to launch them. On average, hospitals have five full-time employees, including clinical staff, tracking and reporting quality measures under value-based models, according to the AHA. They are also spending approximately $709,000 annually on the administrative aspects of quality reporting.

Clinicians won't get a formal chance to weigh in on the future of the proposed oncology model until an actual proposed rulemaking is released. Azar did not offer a timeline as to when that might be.

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