For RT services furnished in an outpatient department of a hospital, the facility services are paid under the Hospital Outpatient Prospective Payment System (OPPS) and the professional services are paid under the PFS. Site Neutrality: Under Medicare Fee-For-Service (FFS), RT services furnished in a freestanding radiation therapy center are paid under the Medicare Physician Fee Schedule (PFS) at the non-facility rate, including payment for the professional and technical aspects of the services. The report identified three key reasons why radiation therapy is ready for payment and service delivery reform: the lack of site neutrality for payments incentives that encourage volume of services over the value of services and coding and payment challenges. The report, which is available on the Center for Medicare and Medicaid Innovation’s (Innovation Center) website, was published in November 2017. In December 2015, Congress passed the Patient Access and Medicare Protection Act, which required the Secretary of Health and Human Services to submit to Congress a report on “the development of an episodic alternative payment model” for RT services.

Since 2014, CMS has been exploring potential ways to test an episode-based payment model for RT services. The final rule (CMS-5527-F) can be downloaded at : The RO Model is included in the final rule entitled Medicare Program Specialty Care Models to Improve Quality of Care and Reduce Expenditures. This fact sheet discusses major provisions of the RO Model.

The RO Model has a five-year Model performance period that begins on Januand runs through December 31, 2025. The aim of this model is to test whether bundled, prospective, site neutral, modality agnostic, episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD), and freestanding radiation therapy centers for radiotherapy (RT) episodes of care reduces Medicare expenditures, while preserving or enhancing the quality of care for Medicare beneficiaries. The Radiation Oncology (RO) Model is an innovative payment model that aims to improve the quality of care for cancer patients receiving radiotherapy treatment, and move toward simplified and predictable payments.

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