上周，CMS宣布了对辐射的修改建议 Oncology (RO) 模型, further solidifying their commitment to mandatory payment 模式和向基于价值的医疗bet8娱乐的过渡. 更新详情 were included the CY 2022 Hospital Outpatient Prospective Payment and 门诊手术中心支付系统(OPPS/ASC)提议规则. 该模型 is slated to begin January 1, 2022, and will run through December 31, 2026.
提醒我什么是RO模型?
的 RO 模型 is a five-year mandatory program in which participants will receive a prospective episode-based payment for radiation therapy (RT) services provided 在90天内. 该模型旨在测试是否具有前瞻性 episode-based payments for RT services will reduce Medicare program 增加支出，提高质量. 该计划将包括所有符合条件的30% 美国48个州和华盛顿特区的RO事件. 值得注意的是，CMS 不 made any changes to the list of core-based statistical areas (CBSAs) that are required to participate in the model since the program’s original announcement 去年9月.
该模式的一个特点是基于情节的支付——这
functions more like a case rate—will be both site neutral and modality
不可知论者. Participants will be physician group practices, hospital outpatient
部门，以及独立的RT中心.
我需要知道什么变化?
尽管CMS提出了更多 than a dozen new changes to the RO 模型, only a few will have a significant 对供应商的影响. 以下是可能影响你的工作的四个关键变化 组织.
1. CMS正在将肝癌从包括的癌症类型列表中删除.
根据利益相关者的反馈和额外的分析, CMS建议将肝癌从模型中移除. 肝癌放疗治疗不断发展, 一线放疗指导有限. 进一步, liver cancer is 不 commonly treated with RT per nationally recognized, 循证临床治疗指南.
的 exclusion of liver cancer will come as a relief to 组织s that treat a large population of liver cancer patients with RT. It means the RO 模型 patient population will likely be easier to manage and will follow more predictable care pathways. 行政和业务负担也将减轻, as 组织s will no longer be required to manage a complex patient population through a new payment model.
2. CMS is removing brachytherapy from the list of included treatment modalities.
CMS’s removal of brachytherapy from the model will likely be welcomed by those providers who frequently use the treatment modality. Brachytherapy is often provided in addition to other forms of RT (known as multimodal care), so patients receive more doses of radiation per episode compared to the standard treatments. 的 inclusion of brachytherapy in the RO 模型 would unintentionally incentivize oncologists to provide less brachytherapy, 即使是临床指征.
进一步, brachytherapy is often delivered by a separate radiation oncologist, 使模型的资金流进一步复杂化. Eliminating brachytherapy from the RO 模型 removes additional decision-making parties (i.e., 提供近距离放射治疗的放射肿瘤学家), meaning there will only be one oncologist managing the patient’s treatment plan—resulting in greater control over the total episode spend.
最后, participants with a high level of brachytherapy in their service mix may now be eligible for the “opt-out” low-volume provision under the RO 模型. Providers that conducted fewer than 20 episodes across all designated modalities in CY 2020 will be eligible to opt out for PY1. 相应的, 因为近距离治疗将不再包括在内, some participants may 不 have sufficient volume in other types of RT modalities (IMRT, 质子束, 等.)，从而使他们有资格选择退出该计划.
3. CMS正在消除参与者“玩弄系统”的能力.”
在RO模型中, several key components of the program are based on the participant’s historical utilization and spend under their 当前的 tax ID number (TIN) or CMS Certification Number (CCN). “当前”是这里的关键字——cms计算支付率, 进行案例组合调整, and determines low-volume opt-out eligibility based on historical utilization under the participant’s 当前的 TIN或CCN. If a participant had recently delivered RT services under a legacy TIN或CCN, 这些bet8娱乐不会影响它们在模型中的状态.
结果是, 一些参与者已经开始“玩弄体制”——也就是说, setting up new TINs to qualify for the low-volume opt-out provision or perhaps earn a more favorable payment rate. 根据拟议规则， CMS will consider and include all legacy TINs and CCNs of all participants.
因此, some participants may see slightly different payment rates than they would have previously under the 当前的 RO 模型. For example: a participating physician group practice changed TINs in 2018. In 2017, 基准期的第一年, they were delivering RT services to a “healthier” population; however, 2018年和2019年, 该诊所的患者人数在视力方面有所增加. Under the 当前的 version of the model, 2017 would 不 affect their case mix adjustment. 然而, 在新版本的模型中, 其中考虑了遗留tin, all three years will be factored into the case mix calculation despite the practice’s TIN change in 2018. 在这个例子中, the practice’s case mix adjustment may be slightly less favorable than under the 当前的 model.
4. CMS is adopting an “extreme and uncontrollable circumstances” (EUC) policy.
由于COVID-19, CMS正在提议增加EUC政策, which will allow CMS to make changes to the RO 模型 to accommodate 当前的 or future pandemics. This will also apply to extreme weather scenarios, such as hurricanes and tornadoes. 如果CMS在地理区域或全国范围内申报EUC, 可以:(1)修正模型履约期限, (2) eliminate or delay certain reporting requirements for RO participants, 及/或(3)修订RO模型的定价方法.
此外, CMS is 当前的ly analyzing whether COVID-19 resulted in a decrease in Medicare fee-for-service (FFS) claim submissions for RT services during 2020 relative to historical levels. 出于这个原因, 根据拟议的欧盟政策, CMS is 当前的ly considering the removal of 2020 data from the calculation of any applicable baseline period or trend factor.
接下来是什么?
的 RO 模型 marks a significant departure from Medicare’s FFS payment approach and is expected to have a substantial 对供应商的影响 of RT services. Cancer centers will need to roll up their sleeves and prepare to make operational and strategic changes to accommodate the new program.
RO模型参与者接下来的主要步骤包括:
- RO模型登录，包括门户注册和访问.
- 操作更新, 包括计费所需的流程更改, 质量跟踪和报告, 收入周期.
- 财务机会分析.
- 采用最佳循证护理途径.
2021年7月29日出版
