For many cancers being treated with radiation therapy, evidence-based standards of care have transitioned to shorter treatment courses. However, Medicare’s outdated fee-for-service approach penalizes radiation oncologists for following those best practices. In May 2024, bipartisan lawmakers introduced a new bill in the U.S. House of Representatives and Senate that would “modernize Medicare reimbursement for radiation therapy, safeguard access to high-quality cancer treatments, improve patient outcomes, and reduce health disparities while generating savings for Medicare,” the legislators said in a May 15 press release.

The Radiation Oncology Case Rate (ROCR) Value-Based Payment Program Act of 2024 (S 4330 and HR 8404), sponsored by U.S. Senator Thom Tillis (R-NC) and U.S. Representatives Brian Fitzpatrick (R-PA), John Joyce, MD (R-PA), Jimmy Panetta (D-CA), and Paul Tonko (D-NY), would shift Medicare’s current per-treatment payments to a more patient-centered approach, the legislators said.

“The current Medicare Part B payment system favors longer courses of cancer treatment and undermines the ability of radiation oncology clinics to provide tailored care,” Panetta said. “By creating a bundled payment system with our bipartisan ROCR Act, we’ll more readily incentivize high-value treatment for patients and potentially reduce the frequency of radiation sessions.  We need to ensure that Medicare is providing the best care possible for beneficiaries while properly compensating providers in their work.”

Among its advancements, ROCR’s Health Equity and Achievement in Radiation Therapy (HEART) initiative would give centers funds to support patients who face transportation barriers accessing and completing their radiation treatments. HEART is based on a model from a National Cancer Institute–funded study that reduced disparities and increased survival for a community in North Carolina. The bill has the following additional key features:

  • Aligns financial incentives with scientifically proven outcomes for episode-based payments
  • Supports shorter treatments for certain cancers, allowing patients more time to work and spend with loved ones
  • Reduces disparities that create barriers for patients from rural and underserved communities to access and complete treatments.
  • Implements a systematic approach to improve quality and protect patient safety through practice accreditation
  • Unifies payments across settings based on hospital technical payments
  • Saves Medicare approximately $200 million over 10 years

“Through ROCR, Congress can build a future where radiation oncology reimbursement is driven by patient needs, not by the number of treatments provided,” Jeff Michalski, MD, MBA, FASTRO, chair of the American Society for Radiation Oncology Board of Directors, said. “This bill represents a pivotal turn in how Medicare values radiation oncology care. By passing it, Congress would ensure that high quality treatment remains accessible for all patients, especially those in rural and underserved communities.”

Whether for curative or palliative intent, radiation therapy is considered standard of care for more than 50% of patients with cancer. In its Access to Quality Cancer Care position statement, ONS maintains that “all persons will have access to equitable, comprehensive, affordable healthcare without discrimination, including populations who are at risk, vulnerable, underserved, or underrepresented.” Advocate for your patients’ access by contacting your lawmakers, sharing your patients’ stories, and asking them to support the bill.