bundling not going away

[RickyScott]

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Internal CMS Transmittal Lays Out Radiation Therapy Bundle Plan | InsideHealthPolicy.com

 

[medgator]

Any way to get the full text from the link ?

 

[Gfunk6]

See link: https://www.astro.org/ASTRO/media/ASTRO/Blog/CMSTransmittal.pdf

Of course the most important info are these 17 mysterious ICD10 codes and the actual reimbursement for codes - neither of which is mentioned

 

[Gfunk6]

Any way to get the full text from the link ?

Here it is:

Internal CMS Transmittal Lays Out Radiation Therapy Bundle Plan
February 13, 2019
CMS in an internal transmittal to contractors dated Feb. 15 lays out a proposal for a prospective bundled payment radiation oncology model that would replace fee-for-service payments in randomly selected geographic areas, a move that comes after HHS Secretary Alex Azar indicated the agency was eying a mandatory radiation therapy demonstration.

A CMS spokesperson told Inside Health Policy the document was inadvertently posted and is for internal planning purposes at this point.

“CMS has and will continue to conduct extensive and ongoing stakeholder engagement regarding a potential radiation oncology bundle,” the agency spokesperson said Feb. 13.

The American Society for Radiation Oncology is happy an alternative pay model is moving forward.

“We are pleased that CMS continues to make progress on an advanced alternative payment model for radiation oncology. We also appreciate that CMS takes stakeholder input seriously and that the agency has provided opportunities for ASTRO and other stakeholders to share our input. We remain committed to working with CMS on policies that will ensure payment stability for radiation oncology practices and the highest quality of care for patients,” said Anne Hubbard, ASTRO’s director of health policy.

Azar in November indicated that CMS was actively exploring a possible mandatory radiation therapy demonstration. Radiation oncologists at the time raised concerns about making such a demo mandatory.

A November analysis from the Advisory Board says the 2015 Patient Access and Medicare Protection Act paved the way for a radiation oncology advanced payment model by freezing payments for freestanding radiation therapy services until this year. The analysis adds that CMS, Congress and the providers were supposed to agree on an APM by that point.

The final physician fee schedule rule for 2019 was estimated to cut payments by 1 percent for radiation oncology in 2019, which is less than the proposed rule initially called for, according to an ASTRO summary.

The transmittal says CMS will allow for “the continuation of discussions and development of business requirements for the implementation of the Prospective Bundled Payments for Radiation Oncology (RO) Model,” and says the Medicare Administrative Contractors should expect to participate in conference calls on the proposal.

CMS is proposing bundled payments for all included radiation therapy services, instead of using Medicare fee-for-service payments, provided in certain randomly selected geographic areas, the transmittal states. The agency would like to include 17 types of cancer in the model.

The agency envisions a 90-day episode for the bundle. The first half of the payment would come when providers bill an initial code triggering the model, and the second half would come when a modified version of the code is billed to trigger the end of the episode. CMS says payment for the technical component would be made through either the physician fee schedule or the hospital outpatient pay system, as both freestanding radiation therapy centers and hospital outpatient departments would participate.

Following a 90-day episode, CMS says participants would be able to bill radiation therapy services as fee-for-service for the same beneficiary for 28 days before a new episode could be triggered.

If a beneficiary dies or enters hospice once the episode has been initiated, providers would still get full payment under CMS’ proposal, even if the beneficiary didn’t finish treatment.

“CMS shall provide further billing instructions to participants through sub regulatory channels of communication, including the Medicare Learning Network (MLN Matters) publications and model-specific webinars,” the transmittal says. -- Michelle M. Stein([email protected]) and John Wilkerson([email protected])



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[Krukenberg]

Astro’s health policy staffer comments on the transmittal:
RO-APM: What we know, what we don’t and what it all means - ASTRO Blog- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

 

[seper]

For patients' sake, some form of RadOnc bundling is overdue.

 

[medgator]

For patients' sake, some form of RadOnc bundling is overdue.

Not to mention the sustainability of Medicare

 

[deleted941485]

Let the hypofrac extravaganza begin!

I can’t wait to see all those old attendings who chastised the new grads about the so called evils of hypofrac suddenly forget all their supposed qualms regarding late toxicity or lack of long term data.

The best thing a new RO can have right now is an exit strategy. Honestly, what specialties ultimately did well with bundling?

 

[DebtRising]

For patients' sake, some form of RadOnc bundling is overdue.

How will this help patients? Genuinely curious

Radiation spending per patient diagnosis is relatively low compared to all other components of care, with generally high utility. All this seems to be is a way to continue to shrink oncology payments in general while not touching drug costs. Life is not full of conspiracies, but people defend their own, and the hhs secretary is a former Pharma exec whose future post is inarguably brighter if the pharma industry is pleased with his work.


Mandatory Rad Onc bundling while maintenance immunotherapy is accepted. Great for patients?

 

[seper]

Bundling should, in theory, eliminate harmful overutilization of radiotherapy in the U.S. (think IG-IMRT for bone mets or faux SBRT). In turn, this may free up resources for those who still lack access to RT for some reason.

Totally different experience where I practice. I'm not in academics, but generally get my referrals directly from ent/surg/pulm who understand exactly what it is we bring to the table. In borderline chemo cases for lung and head and neck, I'm usually making the referral to MO.

My guess is that weak RO depts in academia likely suffer from weak leadership

How will this help patients? Genuinely curious

Radiation spending per patient diagnosis is relatively low compared to all other components of care, with generally high utility. All this seems to be is a way to continue to shrink oncology payments in general while not touching drug costs. Life is not full of conspiracies, but people defend their own, and the hhs secretary is a former Pharma exec whose future post is inarguably brighter if the pharma industry is pleased with his work.


Mandatory Rad Onc bundling while maintenance immunotherapy is accepted. Great for patients?

 

[imhopeful432]

Orthopedics has done pretty well with bundling (both in terms of $$ for the hospitals/MDs and and quality re: amount of time spent in rehab). We have also had some form of bundled payments on the inpatient side since the 1980s, which has done fairly well (length of stay has gone way down and we have decreased hospital LOS than most of our European counterparts).

But agree that bundling won't work for everyone and every specialty (wouldn't be surprised if bundling is a failed experiment in oncology 5-10 years). However, if bundling does happen, I would MUCH rather have a RO specific bundle as advocated by ASTRO that puts us in control/allows independent radiation oncologists to practice...rather than an oncology care model type model only that makes radiation oncology purely a cost center. Also, all the early data from ACOs show (to my surprise) that independent physician led ACOs have done better than large "integrated" hospital systems in terms of actually achieving cost savings (search ACO indepedent physician group vs. hospitals in google), so this could help entrepreneurial radiation oncology practices in the short to medium term at least.

 

[RickyScott]

Bundling is certainly a positive for society. I have brought this up before but anecdotally wanted to hear from those in community if you notice much heavy reliance on conventional fractionation in non academic centers. I do think that "overeliance" on conventional fractionation is probably responsible for a certain number of jobs.

 

[deleted941485]

Bundling is certainly a positive for society. I have brought this up before but anecdotally wanted to hear from those in community if you notice much on heavy reliance conventional fractionation in non academic centers. I do think that overeliance on conventional fractionation is probably responsible for a certain number of jobs.

Like I said...exit strategy. It could be a session at ASTRO this upcoming year.

Titled: Jumping Ship: What’s your shtoyle?

 

[RickyScott]

Doesnt ASTRO owe it to it members to do surveys on this and estimates on how it will affect the job market, because I can tell you that in my area there is virtually no hypofractionation outside of the large hospitals.

 

[OTN]

There’s hypofractionation in the community setting. All 7 radoncs in my region in our community practice have been hypofractionating breast for about 3 years.

I do 30 Gy in 10 fractions for most bone mets. Don’t see much prostate at all (urorads in the area), but I do offer SBRT for low- and intermediate-risk prostate ca.

 

[medgator]

There’s hypofractionation in the community setting. All 7 radoncs in my region in our community practice have been hypofractionating breast for about 3 years.

I do 30 Gy in 10 fractions for most bone mets. Don’t see much prostate at all (urorads in the area), but I do offer SBRT for low- and intermediate-risk prostate ca.

I really think it's a function of age / time from residency, outside of academic practice. Pretty much anyone that trained since the turn of the century is probably doing it, while those who've been out longer and don't follow guidelines, or don't care to, don't