From 2003 to 2009, radiation oncology expenditures overshot the sustainable growth rate target by more than 300% compared with 2002 expenditures. The RO Model has been nearly 20 years in the making. ASTRO issued a comprehensive analysis within 4 days and has begun an aggressive campaign to delay the operational date and to scale back some of the economic impact, but before addressing those factors in more detail, it is instructive to understand how we arrived at this moment. The recent publication of the Final Rule 2 establishing an alternative payment model (APM) for ∼30% of all eligible Medicare fee-for-service radiation therapy episodes nationally has unleashed a justified firestorm of criticism directed at the CMS, largely owing to its refusal to compromise on multiple aspects of the program, including an unrealistic timeline and punitive discount factors. In the wake of the posting of the Radiation Oncology Model (RO model) Final Rule, I believe that it is critical to follow up on Dr Kavanagh’s hopeful comments and ASTRO’s response to the emerging model.
In September 2019, immediate past chair of the American Society for Radiation Oncology (ASTRO) Board of Directors, Dr Brian Kavanagh, published an editorial in the Red Journal entitled “Radiation Oncology APM: Why Us? Why Now?” 1 This was a thoughtful look at the rationale for engaging with the Centers for Medicare and Medicaid Services (CMS) to create a payment model for our specialty that was both fair and predictable, placing value over volume.
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