The absence of such adjustment factors are important in that they explain, in some part, the concerns of those in the RT provider community who take issue with the RO Model. © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). Although the proposed RO Model is consistent with broader trends in the healthcare industry to cut healthcare costs and increase quality through the use of bundled and other alternative (i.e., not fee-for-service) payment methodologies, the RO Model has garnered its fair share of detractors within the RT community. At Mayo Clinic, the needs of the patient come first. Proton beam therapy will be the best option for certain patients and tumor types, while others may benefit from a different approach — another type of radiation therapy or no radiation at all. That means that there is no national rule, so the decision is … This content does not have an English version. It’s essential that you and your primary oncologist submit a request for coverage of your proton therapy … This means highly specialized radiation oncologists work in a multidisciplinary environment that considers all your needs. Make the model retrospective rather than prospective, to allow CMS to reconcile providers’ historical and actual case mix and avoid under or over payments; Replace the RO Model’s historical experience and efficiency adjustments with an adjustment that blends participants’ historical performance and national and regional average performance, as has been done in other models; Lower the discount amount, especially for the technical component (TC) payment, to 2.5% – 2.75%; Incorporate a stop-loss provision into the RO Model; Develop approaches to ensure that appropriate payments are made when providers introduce new service lines or technologies that were not included in their historical data; and. New Technology and RT Therapy. BACKGROUND: This guideline … The AHA believes that the RO Model as described in the NPR would place too much risk and burden on providers with little opportunity for shared savings as a reward. If you don't know the Document ID, use Advanced Search.It … The RO Model is one such alternative payment model. For most tumor sites, a standard course of treatment is five to seven weeks, with treatments delivered five days per week. Proton beam therapy is targeted and helps to spare healthy tissue from the effects of radiation. A single copy of these materials may be reprinted for noncommercial personal use only. In contrast, conventional external beam radiation therapy (EBRT) delivers radiation to all involved tissue, diseased and normal, and targeted tissue receives 60–70% of the intended dose. Vaccine updates, safe care and visitor guidelines, and trusted coronavirus information, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, The Mayo Clinic experience & patient stories. The RT community will be watching and so will we. Also Known As: Proton beam radiation therapy, Proton radiotherapy PRIOR AUTHORIZATION: Required. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. As a result, oncologists and their patients may soon find themselves with fewer (and possibly less effective) RT alternatives to choose from. Specifically: As noted by the AHA in its September 16, 2019 comment letter, although the AHA and its member organizations share a mutual desire with CMS to move towards a more accountable and streamlined system of care, the AHA’s RO Model concerns arise from a difference of opinion regarding how to best pursue this shared goal.

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