Innovating Payment for Radiation Therapy While Improving Quality of Care
- Payment Models & Affordability
This project aims to provide higher-value radiotherapy care while reducing Medicare expenditures & enhancing quality of care for patients. Potential impact includes changes in how co-pays & on making CMS reporting requirements fit seamlessly into clinical, quality, & administrative workflows to reduce clinician burden.
Since 2014, the Centers for Medicare & Medicaid Services (CMS) has explored ways to test an episode-based payment models for primary and specialist health care services. One of these is the Radiation Oncology Alternative Payment Model (RO-APM), which aims to improve the quality of care for cancer patients receiving radiotherapy while also simplifying the payment system and making it more predictable.
Slated to start in the near future, the RO-APM randomly assigns about 30% of radiation therapy centers across the country to participation in the episode-based payment model and covers 15 disease types. Penn Medicine is leveraging its prior experience with the Penn Medicine Independence Blue Cross Radiation Oncology Episode of Care Model (EOC) to innovate payment and improve the quality of care for Medicare beneficiaries.
The goal of the CMS RO-APM model is to provide higher-value radiotherapy care while reducing Medicare expenditures and enhancing quality of care for patients. Penn has been focused enhancing patient experience, especially related to possible changes in how co-pays may be billed in an episode model, and on making CMS reporting requirements fit seamlessly into clinical, quality and administrative workflows to reduce clinician burden.
Radiation Oncology; Penn Medicine Cancer Service Line; Penn Medicine; Independence Blue Cross
Project Leads
-
Danielle Hoffman
Director of Revenue Cycle and Payer Relations, Radiation Oncology, Penn Medicine
-
Katherine Madonna
CPA
Associate Chief Financial Officer, Clinical Practices of the University of Pennsylvania
-
