Jordan Johnson, Founder and Principal at Bridge Oncology and Legal Data Expert, shared on LinkedIn:
“Heading to Boston for ASTRO this weekend? Reframe what you’re listening for and paying attention to!
Radiation oncology is walking into this meeting under real financial pressure, and the next few months will set the tone for 2027.
What’s shaping the landscape right now:
- 2026 hit harder than projected. CMS estimated this year’s coding and payment changes would reduce reimbursement by about 1%. Many practices are reporting double-digit declines instead, and some have made layoffs or frozen hiring.
- 2027 is a mixed bag. The proposed fee schedule shows gains for key treatment delivery codes. But planning, management, and SBRT face cuts, and the conversion factor is down. Your net impact depends entirely on your service mix.
- The rules underneath are shifting. CMS has proposed overhauling how practice expense is calculated, which could hit capital-intensive specialties like ours, and moving quality reporting toward MIPS Value Pathways.
- Clinical progress keeps outpacing the payment model. Hypofractionation, adaptive RT, and AI-driven workflows are better for patients, but per-fraction payment still penalizes doing less, faster.
- Access is fragile. Tens of millions of Americans live in counties with no radiation oncology practice, and rural and freestanding centers are the most exposed.
- Reform is on the table, not in hand. Proposals like ROCR are gaining congressional support, but anything you model today rests on assumptions and historical data that may not match your practice.
So as you sit in sessions and walk the exhibit hall, ask:
- Does this assume the payment environment of three years ago, or the one we’re in now?
- How does this perform if fractions keep dropping and per-code rates keep moving?
- Vendors: will this investment pay off under fee-for-service and under an episode-based model? Can you show me with my own data?
- Does this help me protect access for the patients farthest from care?
The final 2027 fee schedule typically lands in late October or early November, just weeks after you all fly home. The conversations you have in Boston are your chance to get ahead of it. This is more than reimbursement.”
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