Blog Post

How 17 cancer programs are preparing for Medicare's new Radiation Oncology Model

December 8, 2020

    by Lindsey Paul, Deirdre Saulet, and Ashley Riley

    CMS' Radiation Oncology (RO) Model is now set to start on July 1, 2021. We talked to 17 cancer program leaders about how they're preparing to meet participation requirements and succeed on quality performance measures. Keep reading for our insights on four key questions:

    1. Who should be involved in preparation?

    2. What should you do to start preparing?

    3. How are cancer programs addressing the potential financial impacts?

    4. How are cancer programs addressing physician concerns?

    Decision guide: Radiation Oncology Model readiness assessment

    1. Who should be involved in preparation?

    All of the cancer program leaders we spoke with agreed that widespread support beyond the cancer center will be necessary to successfully prepare and plan for the RO Model. Specifically, it's important to inform and involve partners in strategic planning, finance and budgeting, revenue cycle, payer relations, quality tracking and reporting, IT, and operations—in addition to the obvious education and training for all cancer center staff and clinicians.

    Beyond simply educating these stakeholders, many cancer program leaders are including representatives from these departments on a multidisciplinary team they're creating to be responsible for understanding the ins and outs of the RO Model, identifying organizational changes that need to be made before July, assigning responsibility for implementing those changes, and developing a high-level timeline for implementation. One cancer program leader pointed out that it would also be beneficial to include anyone in the health system with experience with accountable care organizations (ACOs), bundles, or other similar value-based payment models, whether or not their experience is specific to oncology.


    Last, but perhaps most important, it's critical to have at least one person from the C-suite on this multidisciplinary team to ensure success in the RO Model is a priority for the entire organization—not just the cancer center. Once assembled, team members can be assigned to various working groups to focus on specific elements of preparation.

    2. What should you do to start preparing?

    There are five key focus areas cancer programs should consider as they prepare for the RO Model: strategy, finance, clinical operations, quality, and IT. We've laid out some of the tasks cancer program leaders should consider within each focus area below. Given the number of tasks within each area and the different expertise required for each, one leader created separate working groups for the five areas, with the strategy working group in charge of coordinating among the other four.

    RO model

    For additional guidance on how to prepare, review our detailed readiness assessment that lays out best practice implementation steps and supporting resources for each RO Model participation requirement and quality measure. CMS has also published a Fact Sheet and FAQ document to address many of the most common questions it has received.

    3. How are cancer programs addressing the potential financial impacts?

    Estimating the financial impact

    Participating organizations need to project the potential impact of the RO Model on their finances, which can be complicated given the number of variables, including case mix, payer mix, patient diagnosis, modalities used, possible recoupment of withholds, and discounts. For help estimating the potential impact on your practice, we recommend checking out CMS' RO Model Payment Calculator Workbook or the workbooks the American Society for Radiation Oncology (ASTRO) created for calculating expected payments:


    CMS RO Model payment calculator workbook

    ASTRO professional component workbook

    ASTRO technical component workbook

    Reducing costs

    To mitigate projected revenue losses, cancer programs are looking to cut expenses. One opportunity several cancer programs we've spoken with are thinking about is ensuring they're utilizing their advanced practice providers (APPs) at top of license, which reduces the need to hire additional physicians. While other cost-cutting strategies didn't come up in our conversations, some of the top approaches we've seen in the past include reducing care variation through adoption of clinical pathways and evaluating new technology investments based on their potential to reduce costs rather than securing favorable reimbursement.

    When deciding where to cut costs, one cancer program leader encouraged others to consider the impact of each potential cut on their competitiveness and downstream revenue, not just the direct cost savings. For instance, many support services (e.g., integrative medicine services, nutrition support) are not reimbursable and, therefore, may seem like an easy target. However, getting rid of these services could negatively impact patients' experiences and hurt patient loyalty, the cancer program's reputation, and ultimately future clinical volumes, even though it might save money up front.

    Cancer Patient Experience Survey Resources

    Maximizing revenue

    In addition to cutting expenses, cancer programs plan to focus on improving efficiency to increase capacity and thereby revenues. For instance, leveraging the entire care team, from APPs to radiation technicians, to ensure everyone is able to practice at top of license and reduce time spent on low-value activities. And finding ways to streamline patient and room prep can drive treatment capacity.


    Increasing adoption of hypofractionation is another strategy to maximize revenue, as decreased visit volumes per patient means organizations can theoretically treat more patients overall across a year. Currently, only a fraction of eligible patients receives hypofractionation, indicating plenty of opportunity for further adoption among cancer programs.

    Oncology referral strategy toolkit

    Reducing total cost of care

    Although RO Model participants aren't responsible for total cost of care, many of the cancer leaders we spoke with are also considering implementing strategies to reduce total cost of care because this aligns with both patients' interests and the intentions of the Model. Specifically, they expressed interest in providing additional care management services, including access to urgent care, symptom management, palliative care, remote monitoring, and depression screening (which is required under the Model).

    Playbook for Maximizing Oncology Margins

    4. How are cancer programs addressing physician concerns?

    Radiation oncologists are concerned about the effects of the RO Model on compensation, clinical practice, and their ability to make independent decisions regarding patient care. Cancer programs that currently operate under productivity-based compensation models, which is nearly all of them, expect more difficulty gaining physician buy-in. The RO Model provides a good opportunity to revisit physician alignment and compensation models, as productivity-based compensation models will likely be impacted.

    Since the RO Model is mandatory, radiation oncologists have the incentive to work with cancer program leadership to make the practice changes needed to succeed under the Model. Cancer program leaders hope to capitalize on this by involving physicians in identifying and implementing necessary changes to increase the likelihood they can address physicians' concerns head-on.

    Resources to help you engage your oncology staff

    Stay tuned for more best practices for success and updates on the RO Model across the coming months. For now, start preparing for the Model by educating your workforce, enlisting key stakeholders to develop your strategy, bracing for the financial impact, and engaging your physicians.

    Decision guide: Radiation Oncology Model readiness assessment

    innovations in radiation oncology

    For a detailed list of steps to meet each participation requirement and quality measure included in the RO Model, review our RO Model Readiness Assessment.

    Check out the Resources


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