The Centers for Medicare & Medicaid Services (CMS) proposed two mandatory payment models through the Center for Medicare and Medicaid Innovation that will test prospective episode-based payments for radiation oncology therapy and end-stage renal disease (ESRD) treatment.
Radiation Oncology Therapy Model
Participants in the radiation oncology therapy model will include physician group practices, hospital outpatient departments, and freestanding radiation therapy centers. The model is intended to reduce Medicare expenditures and improve quality of care.
Under the model, CMS would make prospective, episode-based payments based on a patient’s cancer diagnosis. These payments would cover radiotherapy services furnished in a 90-day episode for the 17 cancer types meeting the included criteria. The model would establish a common, adjusted national base payment amount for each episode, regardless of where it is furnished, and transition to site-neutral payments.
Participation would be mandatory for providers that furnish services within randomly selected geographic areas.
The five year model is projected to begin on Jan. 1 or April 1, 2020, and end Dec. 31, 2024.
ESRD Treatment Choices (ETC) Model
The ETC model would adjust certain Medicare payments to facilities and clinicians managing ESRD beneficiaries through upward or downward payment adjustments based on their home and transplant rates to increase use of home dialysis and rates of kidney and kidney-pancreas transplants.
The ETC model would be mandatory for certain providers in randomly selected geographic areas and account for approximately 50 percent of adult Medicare beneficiaries with ESRD.
Payment adjustments for selected participants would apply to applicable Medicare claims with dates from Jan. 1, 2020, through June 20, 2026.
Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.