On July 10, 2019, The Center for Medicare and Medicaid Innovation (CMMI) proposed a five-year, mandatory episodic payment model for 17 cancer types treated using radiation oncology. Model participants will receive prospective, episode-based payment amounts for RT services furnished during a 90-day episode of care, instead of regular Medicare fee-for-service (FFS) payments throughout the model performance period. The model’s aim is to test whether episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD) and freestanding radiation therapy centers for radiotherapy (RT) will reduce Medicare expenditures, while preserving or enhancing the quality of care for Medicare beneficiaries. The five-year model is currently projected to begin either January 1, 2020, or April 1, 2020, and end December 31, 2024. CMMI estimates the model will save $260 million dollars over its five-year life by impacting approximately 350,000 episodes.
CMMI Radiation Oncology Model: HFMA Overview
Related Articles | Bundled Payment
After big payouts, Medicare may throttle back bundled payment program
Most BPCI-A participants could see bonuses dry up if proposed changes in the program are implemented.
Bundled payment participants face choices on 2020 performance measurement, continued participation
CMS further detailed how hospitals should evaluate their 2020 options and whether to continue in the BPCI-A model.
Where are Medicare value-based payment models headed after COVID-19?
The pandemic-driven changes in policies, payment and patient attitudes could change participation in and provider approaches to value-based payment models, say advisers.
Mandatory bundled payment program for joint replacement makes changes to accommodate hospitals during COVID-19
Medicare’s largest mandatory bundled payment program is striving to adapt to the unique challenges the coronavirus has created for its hospital participants.