RO Model
Radiation Oncology Model
The Radiation Oncology (RO) Model aims to improve the quality of care for cancer patients receiving radiotherapy (RT) and move toward a simplified and predictable payment system. The model tests whether prospective, site-neutral, modality-agnostic, episode-based payments reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries.
Innovation
Prospective, site-neutral, modality-agnostic, episode-based payments that are split into professional and technical components, establishing a common national base payment amount regardless of the setting where care is furnished.
The Problem
The lack of site neutrality for payments; incentives that encourage volume of services over the value of services; and coding and payment challenges in radiotherapy.
The Solution
Changing the way RT services are currently paid from fee-for-service to prospective, site-neutral, modality-agnostic, episode-based payments to incentivize physicians to deliver higher-value RT care.
Expected Outcomes
Reduced Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries.
Model Goals
- Improve the quality of care for cancer patients receiving radiotherapy
- Move toward a simplified and predictable payment system
- Reduce Medicare expenditures while preserving or enhancing quality of care
Patient Eligibility
Medicare beneficiaries receiving radiotherapy for included cancer types.
- Must be receiving radiotherapy for included cancer types
- Must receive a RO Model Beneficiary Notification Letter
Provider Eligibility
RT providers and suppliers that furnish RT services within randomly selected CBSAs.
- Must furnish RT services within randomly selected CBSAs
- Must be a Medicare-enrolled PGP, HOPD, or freestanding radiation therapy center
- Must participate as a Professional, Technical, or Dual participant
Care Categories
Oncology
Program Benchmarks & Thresholds
financial
operational
quality
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