What's Happening?
U.S. Representative Paul Tonko (D., N.Y.) is a sponsor of the Radiation Oncology Case Rate Act (ROCR Act), H.R.2120, which aims to stabilize reimbursement for radiation oncology services. This legislative effort comes in response to significant discrepancies
between Medicare's projected 1% cut to radiation oncology reimbursement for 2026 and the actual experience of many physicians, with over two-thirds reporting declines of 10% or more, and some as high as 20% to 30%. The American Society for Radiation Oncology (ASTRO) has highlighted this gap, noting that the Centers for Medicare & Medicaid Services (CMS) impact tables, which blend various types of facilities and service mixes, often fail to reflect the financial realities faced by independent and rural cancer centers. The ROCR Act proposes a structural fix by stabilizing reimbursement around an individualized treatment plan rather than the quantity of treatment delivered, moving away from annual code adjustments that can create volatility.
Why It's Important?
The financial instability caused by Medicare reimbursement cuts poses a significant threat to patient access to cancer care, particularly in rural and freestanding radiation oncology centers. These centers, which often operate on thin margins, are disproportionately affected by payment reductions, leading to potential closures, consolidations, or sales. A study published in the International Journal of Radiation Oncology, Biology, Physics revealed that 68.5% of U.S. counties had no radiation oncology practice site as of 2025, impacting over 50 million people. The ROCR Act is crucial because it seeks to ensure that payment policies support the continued operation of these vital facilities, especially given that radiation therapy often requires daily visits over several weeks. Without stable reimbursement, the existing disparities in cancer care access could worsen, forcing patients to travel long distances for treatment or delay critical interventions, ultimately affecting health outcomes.
What's Next?
The ROCR Act, with bipartisan sponsors including Representative Tonko, is gaining support from nearly 140 organizations, according to ASTRO. While the formal comment window on the 2027 Medicare Physician Fee Schedule has closed, the final rule has not yet been issued. The proposed 2027 rule offers some increases for treatment delivery codes but also includes cuts to planning, management, and stereotactic body radiotherapy codes, and a decrease in the conversion factor. This mixed outlook underscores the ongoing need for comprehensive payment reform, which the ROCR Act aims to provide. Stakeholders, including health system leaders and FQHCs, are advised to audit their 2026 revenue, model the 2027 proposal at the code level, and document patient access impacts to inform ongoing discussions with CMS and Congress. The ultimate goal is to shift towards a case-rate approach that provides more predictable revenue and reduces incentives to adjust treatment plans based on reimbursement codes.
Beyond the Headlines
The debate over Medicare reimbursement for radiation oncology highlights a broader systemic issue within the U.S. healthcare system: the challenge of balancing cost containment with ensuring equitable access to specialized medical care. The current fee-for-service model, with its annual code adjustments, creates an environment of financial uncertainty that disproportionately affects smaller, independent, and rural providers. This instability can stifle investment in new technologies and facilities, and exacerbate healthcare disparities. The ROCR Act's proposal for a case-rate approach represents a move towards value-based care, where reimbursement is tied to the overall treatment plan rather than individual services. This shift could encourage more holistic patient care and greater financial predictability for providers, but it also requires careful implementation to avoid unintended consequences and ensure that complex cases are adequately compensated. The long-term success of such reforms will depend on continuous collaboration between policymakers, healthcare providers, and patient advocacy groups.
