Last week, CMS announced proposed changes to the Radiation 肿瘤学(RO)模式,进一步巩固了他们对强制性付款的承诺 models and the transition to value-based care delivery. Details of the update 包括2022年CY医院门诊预期付款和 门诊手术中心支付系统(OPPS/ASC)提议规则. The model 定于2022年1月1日开始,将持续到2026年12月31日.
Remind Me—What is the RO Model?
The RO Model 这是一个为期五年的强制性项目,参与者将获得一份 对所提供的放射治疗(RT)bet8娱乐进行基于发作的前瞻性支付 during a 90-day period. The model is designed to test whether prospective RTbet8娱乐的分期付款将减少医疗保险计划 expenditures and enhance quality. The program will include 30% of all eligible RO episodes in the lower 48 states and Washington, DC. Notably, CMS has not 对基于核心的统计区域(cbsa)列表进行了任何更改 自该计划最初公布以来,要求参加该模式 last September.
A hallmark of the model is that the episode-based payment—which
功能更像一个案件率-将是站点中立和形式
agnostic. Participants will be physician group practices, hospital outpatient
departments, and freestanding RT centers.
What Changes Do I Need to Know About?
Although CMS proposed more 比十几个新的变化,以RO模型,只有少数将有显著的 impact on providers. Below are four key changes that may affect your organization.
1. CMS is removing liver cancer from the list of included cancer types.
In response to stakeholder feedback and additional analysis, CMS has proposed removing liver cancer from the model. The treatment of liver cancer with RT services continues to develop, with limited guidance for first-line use of radiotherapy. Further, 肝癌在全国范围内并不常用放疗治疗, evidence-based clinical treatment guidelines.
将肝癌排除在外对于那些用RT治疗大量肝癌患者的组织来说是一种解脱. 这意味着RO模式的患者群体可能更容易管理,并将遵循更可预测的护理途径. Administrative and operational burden will also decrease, 因为组织将不再需要通过新的支付模式来管理复杂的患者群体.
2. CMS正在从纳入的治疗方式列表中删除近距离治疗.
CMS从模型中删除近距离治疗可能会受到那些经常使用这种治疗方式的提供者的欢迎. 除了其他形式的放射治疗外,还经常提供近距离治疗(称为多模式治疗)。, 因此,与标准治疗相比,患者每次接受的辐射剂量更多. 将近距离治疗纳入RO模型会无意中激励肿瘤学家减少近距离治疗, even if it is clinically indicated.
Further, brachytherapy is often delivered by a separate radiation oncologist, further complicating the funds flow of the model. 从RO模型中剔除近距离治疗会消除额外的决策方.e., the radiation oncologist who delivers brachytherapy), 这意味着只有一名肿瘤学家管理病人的治疗计划,从而更好地控制总花费.
Finally, 在其bet8娱乐组合中有高水平近距离治疗的参与者,现在可能符合“选择退出”模式下的小批量提供的资格. 2020年在所有指定模式下进行少于20次治疗的提供者将有资格选择退出PY1. Accordingly, as brachytherapy will no longer be included, 一些参与者在其他类型的放疗方式(IMRT)中可能没有足够的容量, proton beam, etc.), thereby qualifying them to opt out of the program.
3. CMS正在消除参与者“玩弄系统”的能力.”
In the RO Model, 该计划的几个关键组成部分是基于参与者的历史使用情况和当前税号(TIN)或CMS认证号(CCN)下的支出。. “Current” is the operative word here—CMS calculates payment rates, makes case mix adjustments, 并根据参与者的历史使用情况确定低容量选择退出资格 current TIN or CCN. 如果参与者最近在遗留TIN或CCN下交付了RTbet8娱乐, those services would not impact their status in the model.
As a result, some participants have begun “gaming the system”—that is, 建立新的tin以符合小批量选择退出条款或可能获得更优惠的付款率. Under the proposed rule, CMS将考虑并包括所有参与者的所有遗留tin和ccn.
Therefore, 一些参与者可能会看到与当前RO模式下的付款率略有不同. 例如:一个参与的医师团体实践在2018年改变了tin. In 2017, the first year of the baseline period, they were delivering RT services to a “healthier” population; however, in 2018 and 2019, the practice’s patient population increased in acuity. 在当前版本的模型下,2017年不会影响他们的案件组合调整. However, in the new version of the model, in which legacy TINs are considered, 尽管该做法的TIN在2018年发生了变化,但所有三年都将纳入案件组合计算. In this example, 这种做法的案件组合调整可能比目前的模式稍微不利一些.
4. CMS正在采取“极端和不可控情况”(EUC)政策.
As a result of COVID-19, CMS is proposing the addition of an EUC policy, 哪些将允许CMS对RO模型进行更改以适应当前或未来的流行病. 这也适用于极端天气情况,如飓风和龙卷风. If CMS declares an EUC for a geographic region or nationwide, it may: (1) amend the model performance period, (2)取消或延迟RO参与者的某些报告要求, and/or (3) amend the RO Model’s pricing methodology.
Moreover, CMS目前正在分析2019冠状病毒病是否导致2020年医疗保险bet8娱乐收费(FFS)索赔提交量相对于历史水平下降. For this reason, under the proposed EUC policy, CMS目前正在考虑从任何适用的基准期或趋势因素的计算中删除2020年的数据.
What’s Next?
RO模式标志着与医疗保险的FFS支付方式的重大背离,预计将对RTbet8娱乐的提供者产生重大影响. 癌症中心需要卷起袖子,准备在操作和战略上做出改变,以适应新的项目.
Key next steps for RO Model participants include:
- RO Model onboarding, including portal registration and access.
- Operational updates, including process changes required for billing, quality tracking and reporting, and revenue cycle.
- Financial opportunity analysis.
- Adoption of optimal and evidence-based care pathways.
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