Reimbursement


Philips Cautions on CMS Radiation Oncology Plan

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October 10, 2019

Philips Cautions on CMS Radiation Oncology Plan

Philips Healthcare is urging the Centers for Medicare & Medicaid Services (CMS) to proceed with caution in creating a five-year demonstration project that would pay providers a set fee to cover radiation oncology services for 17 different types of cancer. The proposed fee—often referred to as a bundled payment or episode-based payment—would cover radiation services for 90 days after a patient begins treatment. In comments filed with CMS, Philips said it strongly supported the transition of the Medicare program from pay-for-service to pay-for-value, but that the proposed demonstration project raises concerns over patient safety, utilization, and clinical efficacy.

Highlights:
  • Overutilization:  Philips said that the large reduction in payment proposed for the model could create financial incentives for clinicians to provide a higher volume of services than patients need.  
  • Patient Safety: Overuse that could result from the project raises concern for patient safety, said Philips, such as side effects from overexposure of healthy tissue to radiation. The company urged CMS to add clinical outcomes measures to help monitor safety and quality.
  • Scope: Philips said that the breadth of the proposed project underscores safety concerns in light of the fact that CMS would mandate participation by providers that furnish 40% of all radiation oncology in the country. The company urged CMS to make the project voluntary rather than mandatory.