Who is in the room with you?

Here’s a novel take on the RO-APM, not from a legislator or academician, but from an affected radiation oncologist practicing in a rural clinic. His main beef is, per usual, those who actually live and breathe radiation oncology have largely been left out of any decision-making. In fact, practicing in an included zip code disqualifies you from serving as the RO-APM medical director. What? If that weren’t the case, the RO-APM probably wouldn't include novel time-consuming reporting requirements that buy you bonuses or penalties, a stipulation that not only muddies any cost savings analysis but also ensures the transition is uniquely burdensome for smaller practices with less infrastructure. It also would be obvious that lumping treatments for things like bone and brain mets into any preexisting 90-day episode, meaning those courses won’t be reimbursed, indirectly disincentives early and appropriate palliative care. While logic points to the model heightening treatment disparities in areas of most need, let’s be fair to CMS and look back at how many of their 54 previous “innovative” models have resulted in the true goal of significant cost savings: that would be five. | Luh, JCO Oncol Pract 2021 & Berwick, JAMA 2021

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