Amar Rewari, Chief of Radiation Oncology at Luminis Health, shared a post on LinkedIn:
“Radiation oncology isn’t standing still.
Our payment model largely is.
Yesterday at the Community Oncology Alliance meeting, I joined a panel on radiation oncology reimbursement challenges with Casey Chollet-Lipscomb, MD, FASTRO and Ajay Dubey, moderated by Ted Okon, thank you Ted for the invitation.
Over the past decade, radiation oncology reimbursement under the MPFS has evolved through changes in clinical labor pricing, equipment revaluation, E&M, and most recently the transition from G-codes for treatment delivery to codes tied more closely to HOPPS APC-based practice expense.
That shift toward hospital-aligned payment is a meaningful step forward and reflects how care is actually delivered today.
At the same time, the clinical side of our field has advanced quickly.
Hypofractionation is a clear win. Fewer treatments, less burden, better experience for patients.
But in a fee for service structure, fewer treatments per patient also means less revenue per patient.
So the operational reality shifts.
What used to be sustainable at 12 to 15 patients on treatment now often requires 20 to 25 just to maintain a center, with margins hovering near break even. That is a real challenge in rural and community settings and raises important questions about long term patient access as centers close or consolidate.
It also has ripple effects. Many of the services patients rely on, including navigation, survivorship, nutrition, and social work, are supported by the same margins.
And as pressure builds, it becomes harder to consistently invest in the next generation of technology that improves targeting, spares normal tissue, and drives better outcomes.
None of this is about doing less for patients. It is about making sure the system supports doing the right thing.
The opportunity now is to build on recent progress and move toward more stable, modern payment approaches. Models like the radiation oncology case rate model (ROCR) aligned with hospital payments could better reflect how care is delivered today while preserving access and supporting innovation.
We have made meaningful clinical progress.
Now the payment model needs to catch up.”
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