Oncologists Wary Of Possible Mandatory Radiation Demo

November 15, 2018

Radiation oncologists are concerned about the possibility of mandatory participation in a radiation oncology demonstration after HHS Secretary Alex Azar indicated such a model was on the way. Ted Okon, executive director of the Community Oncology Alliance, said layering mandatory demonstrations on top of the voluntary Oncology Care Model doesn’t make much sense.

The American Society for Radiation Oncology has been working on a radiation oncology alternative pay model for years, and ASTRO CEO Laura Thevenot said the group is pleased such an APM is getting closer to reality. But there is worry about the possibility that such a demonstration would now be mandatory from the start.

“While ASTRO is enthusiastic about the prospects for a RO-APM, we have concerns about the possibility of launching a model that required mandatory participation from all radiation oncology practices at the outset. ASTRO recognizes that mandatory and voluntary models can take many different forms and we look forward to working with Secretary Azar and CMMI to determine the best approach for the field of radiation oncology,” Thevenot said.

Azar last week told the Patient-Centered Primary Care Collaborative that HHS “intend[s] to revisit some of the episodic cardiac models that we pulled back and are actively exploring new and improved episode-based models in other areas, including radiation oncology.” He added that anyone that doubted his commitment to such models should look at the mandatory International Pricing Index model the agency recently laid out. That model, however, was put forward in a prerule notice, rather than proposed rulemaking and GOP lawmakers are gauging how serious the agency is about moving forward.

Okon said that CMS on the one hand has the Oncology Care Model, which is a voluntary model on which the agency has worked with providers and shows the way such collaboration could work. On the other hand, he said, are the mandatory models — both the International Pricing Index and a potential radiation oncology model — and to bring those in while voluntary models are still running doesn’t make much sense.

Okon said the models could overlap, and it would be hard to separate out the effects of each individual demonstration. He also said that mandatory models are used when practices likely wouldn’t volunteer to participate in a program, and Okon doesn’t believe that’s what Congress had in mind for the innovation center. Mandatory models, Okon said, overstep executive power.

Thevenot said any radiation oncology model would be a significant departure from the status quo, and the group wants to work with the innovation center and Azar to make sure practices have payment stability and access for beneficiaries is protected. — Michelle M. Stein (mstein@iwpnews.com)