Findings

(a) Findings Congress finds the following: (1) Radiation therapy is the careful use of various forms of radiation, such as external beam radiation therapy, to treat cancer and other diseases safely and effectively. Radiation oncologists develop radiation treatment plans and coordinate with highly specialized care teams to deliver radiation therapy. Nearly 60 percent of cancer patients will receive radiation therapy during their treatment. (2) In 2021, the Centers for Medicare & Medicaid Services reported approximately $4,200,000,000 in total spending for radiation oncology services between the Medicare physician fee schedule and hospital outpatient departments. (3) The Centers for Medicare & Medicaid Services has historically faced challenges in determining accurate pricing for services that involve costly capital equipment, resulting in fluctuating payment rates under the Medicare physician fee schedules for services involving external beam radiation therapy. Additionally, the Medicare physician fee schedule has inadequately recognized the professional expertise physicians and nonphysician professionals need to deliver radiation therapy. (4) The current payment systems incentivize greater volumes of care while bundled payments incentivize patient centered, efficient, and high value care. (5) In 2017, the Centers for Medicare & Medicaid Services recognized that the Medicare payment systems were not adequately addressing radiation oncology services, and the Center for Medicare & Medicaid Innovation released a congressionally requested report on the pursuit of an alternative payment model for radiation oncology (referred to in this section as the Radiation Oncology Model) that addresses the issues in the Medicare physician fee schedule and the Medicare hospital outpatient prospective payment system payment methods. (6) Concerns regarding the proposed Radiation Oncology Model included the significant payment reductions proposed in the model that would jeopardize access to high-quality radiation therapy services and the onerous reporting requirements for participating providers. The Radiation Oncology Model saw indefinite implementation delays. (7) It is necessary, therefore, to create a payment program for radiation oncology services that appropriately recognizes the value of quality radiation oncology services through its financial incentives while containing costs and providing patient-centered care.