Radvocates applaud bipartisan bill that would end decade-long decline in Medicare reimbursement
Radvocates are applauding a bipartisan bill introduced on Wednesday that aims to end a decade-long decline in Medicare payments to physicians.
The Radiation Oncology Case Rate (ROCR) Value-Based Program Act of 2024 seeks to modernize reimbursement for radiation therapy. Advances in cancer treatment have led to shorter courses, but fee-for-service medicine penalizes radiation oncologists who follow “best practices in care,” supporters note.
In addition, the program would unify payments across settings based on hospital technical fees and generate Medicare savings of about $200 million.
“The current Medicare Part B payment system favors longer courses of cancer treatment and undermines the ability of radiation oncology clinics to provide tailored care,” co-sponsor and Rep. Jimmy Panetta, D-Calif., said May 15. “By creating a bundled payment system with our bipartisan ROCR Act, we’ll more readily incentivize high-value treatment for patients and potentially reduce the frequency of radiation sessions.”
Others introducing the House bill Wednesday included Reps. Brian Fitzpatrick, R-Penn., John Joyce, MD, R-Penn., and Paul Tonko, D-N.Y. Sen. Thom Tillis, R-N.C., also is sponsoring a companion version of the bill in the Senate.
One of the legislation’s “most impactful components,” according to Panetta and colleagues, is its evidence-based approach to reducing cancer treatment disparities. Under ROCR’s Health Equity and Achievement in Radiation Therapy initiative, centers would receive funds to help patients who face transportation barriers when accessing treatment.
Reimbursements for radiation therapy under the Medicare Physician Fee Schedule have declined about 23% over the past decade. The bill seeks to end this trend and build off strengths from the shelved Radiation Oncology Alternative Payment Model. It would maintain the previous model’s episode-based payments while eliminating “outsized” cuts and “burdensome” quality requirements.
The previous model also did not incorporate mechanisms to address disparities in cancer care. ROCR would ensure access, with ASTRO labeling it “tragic when transportation obstacles get in the way of curing cancer.”
“Through ROCR, Congress can build a future where radiation oncology reimbursement is driven by patient needs, not by the number of treatments provided,” Jeff Michalski, MD, MBA, chair of the American Society for Radiation Oncology (ASTRO) Board of Directors, said in a statement. “This bill represents a pivotal turn in how Medicare values radiation oncology care. By passing it, Congress would ensure that high quality treatment remains accessible for all patients, especially those in rural and underserved communities.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.