Top Line: ASTRO has officially proposed a new paradigm for radiation oncology reimbursement.
The Study: If you haven’t heard much about the RO-APM lately, that’s because concerted efforts by key radiation oncology stakeholders have continually prevented its implementation. But the status quo ain’t great, either, with average Medicare slashes in annual reimbursements by over 20% in the last decade—a trend we can all expect to continue at alarming rates. So what now? ASTRO is proposing the Radiation Oncology Case Rate (ROCR) model which is basically what it sounds like, transitioning us from a fraction-based to patient-based reimbursement paradigm. The thought is that this will buffer against sharp declines in the number of fractions used to treat our bread and butter cases (read: breast and prostate) that isn’t being offset by the increase in case volume among aging baby boomers. Important exclusions from the current draft are protons, brachytherapy, radiopharmaceuticals, inpatient services, and all services at PPS-exempt centers. That last one really has folks raising an eyebrow as it's difficult to see stakeholders from these institutions weighing in on any of this without skin in the game.
TBL:Use the Excel plug-and-play modeling tool included on the website above to estimate how your practice would fare with ROCR, and let ASTRO know the results. | ASTRO 2023
The Study: If you haven’t heard much about the RO-APM lately, that’s because concerted efforts by key radiation oncology stakeholders have continually prevented its implementation. But the status quo ain’t great, either, with average Medicare slashes in annual reimbursements by over 20% in the last decade—a trend we can all expect to continue at alarming rates. So what now? ASTRO is proposing the Radiation Oncology Case Rate (ROCR) model which is basically what it sounds like, transitioning us from a fraction-based to patient-based reimbursement paradigm. The thought is that this will buffer against sharp declines in the number of fractions used to treat our bread and butter cases (read: breast and prostate) that isn’t being offset by the increase in case volume among aging baby boomers. Important exclusions from the current draft are protons, brachytherapy, radiopharmaceuticals, inpatient services, and all services at PPS-exempt centers. That last one really has folks raising an eyebrow as it's difficult to see stakeholders from these institutions weighing in on any of this without skin in the game.
TBL:Use the Excel plug-and-play modeling tool included on the website above to estimate how your practice would fare with ROCR, and let ASTRO know the results. | ASTRO 2023