Radiation Oncology Alternative Payment Model (APM): An Introduction and Primer for the Proposed Rule for Practices and Providers

Abstract

Purpose: The Radiation Oncology Alternative Payment Model (RO-APM) is an alternative payment model under which Medicare patients would be reimbursed using an episode-based payment schema rather than the current fee-for-service schema. The Center for Medicare and Medicaid Services Innovation Center has published a proposed rule for the RO-APM. However, there is no accessible resource that summarizes information about the proposed rule in an easily understandable form. Methods and Materials: Information regarding the RO-APM was accessed through the Center for Medicare and Medicaid Services Innovation Center website and listening sessions and review of the proposed rule. We summarize the most important information regarding the background, mechanics, and timeline of the proposed rule to facilitate wider understanding in the radiation oncology community and answer commonly held questions. Results: The proposed rule for the RO-APM would cover 40% and have widespread effect on the future of radiation oncology. We provide a primer that summarizes important information regarding the rule for practices and providers. Conclusion: The proposed RO-APM will change the landscape of radiation oncology reimbursement. Understanding the implications of the model will be key to maintining a successful practice.