COA Statement on Proposed Radiation Oncology Alternative Payment Model

July 11, 2019

COA Supportive of CMMI Models that Advance Value-Based Care, but Remains Fundamentally Opposed to Mandatory Model Participation; In-Depth Analysis of Proposed Radiation Oncology Model Needed 

Based on an initial review of the just announced Centers for Medicare & Medicaid Services’ (CMS) Radiation Oncology Alternative Payment Model, the Community Oncology Alliance (COA) has deep reservations and fundamental opposition to a proposed mandatory or “required” CMS Innovation Center (CMMI) model. Radiation therapy is a powerful, complex part of cancer care for patients. While the proposed CMMI model does include a much-needed policy proposal to implement site-neutral payments, COA absolutely does not support mandatory CMMI models.

If models are reasonable and would advance value-based care, then voluntary provider participation will be robust. By their very nature, mandatory models force providers into new models and/or reimbursement of care. These can subject vulnerable patients with cancer and other serious diseases to disruptions in care that they need and are guaranteed and entitled to under Medicare. Patients should not be forced into government experiments and tinkering with their health care, especially without physician involvement in the model development and voluntary participation of patients’ providers, who are the guardians of their medical care.

COA is a strong supporter of CMMI and is committed to increasing the quality of care for patients with cancer and decreasing costs, as well as supporting value-based models that can positively impact costs and utilization. This is why COA remains heavily invested in ensuring that the ongoing CMMI Oncology Care Model (OCM) is a success for patients and practices. Community oncologists are concerned about the escalating prices and costs of cancer drugs and treatments, as well as correspondingly higher hospital-related costs. As leaders in the delivery of cancer care, we are mindful of our responsibility to be good stewards of costs we can control, including the utilization of drugs and services.

It should be noted that mandatory CMMI “models” are not in the charter of CMMI as written into law by Congress. If CMS implements a mandatory model through the CMMI, it must rely on Section 1115A of the Patient Protection and Affordable Care Act for authority to do so. However, according to Section 1115A, the Secretary of the Department of Health and Human Services (HHS) cannot select for testing any model it chooses. Rather, the Secretary is permitted to select for testing only “models where the Secretary determines that there is evidence that the model addresses a defined population for which there are deficits in care leading to poor clinical outcomes or potentially avoidable expenditures.” In addition to these criteria, in phase 1 of a test, HHS is required to undertake an evaluation of each model involving the “quality of care furnished under the model, including measurement of patient-level outcomes…” and changes in spending. While HHS may waive specified statutory requirements in phase 1, such waiver is limited. The waiver applies only “as may be necessary solely for purposes of carrying out” (emphasis added) the testing in phase 1. 

Clearly, the proposed mandatory radiation model violates the charter of CMMI as given to it by Congress.

Furthermore, careful consideration also needs to be given to how mandatory models will affect the significant investment and progress our country has made in other ongoing quality and value reform projects. CMS must consider the impact that new mandatory models would have on patients that are already benefitting from the OCM and other ongoing commercial value-based payment models. 

COA will embark on a thorough evaluation of the proposed radiation oncology model and looks forward to submitting formal comments on it. More importantly, COA looks forward to working closely with the Trump Administration and CMS to address our concerns with mandatory or “required” CMMI models in our quest to ensure the best possible care is available for the patients with cancer we serve. Developing models with meaningful provider input will ensure initiatives that protect patients and garner national voluntary provider participation.