Recent national survey data from the American Society for Radiation Oncology (ASTRO) have shown that further cuts to Medicare reimbursement for radiation therapy would increase patient wait times for cancer treatment and force clinic downsizing. Nearly all (96%) of the 675 physicians responding to the survey said that patient access will suffer under another cut, and 7 in 10 respondents believe the impact will be significant.
On May 19, 2025, radiation oncologists from across the country were on Capitol Hill urging lawmakers to pass the bipartisan Radiation Oncology Case Rate (ROCR) Act before additional Medicare cuts are proposed. The ROCR Act would stabilize Medicare payments, protect patient access, and enhance cancer treatment outcomes by shifting from an outdated, volume-based system to a value-based, bundled-payment model.
Howard M. Sandler, MD, FASTRO
“More than a million Americans rely on radiation therapy each year, but relentless Medicare reimbursement cuts, harmful prior authorization delays, and insufficient cancer research funding are threatening patients’ access to this life-saving care,” said ASTRO Board of Directors Chair Howard M. Sandler, MD, FASTRO. “We’re asking Congress to help safeguard access to affordable, high-quality care for people with cancer by passing legislative solutions including the ROCR Act this year.”
What Is the ROCR Act?
Reimbursement for radiation therapy under Medicare has fallen 25% since 2013. Ongoing cuts are compounded by rising costs and declining use as the field moves toward shorter treatments for many cancers. Increasing financial pressures from these factors, in turn, drive practice consolidation, reducing competition and forcing many patients to travel farther for cancer care.
The ROCR Act (S.1031, HR.2120) is led by Senators Thom Tillis (R–NC) and Gary Peters (D–MI) and Representatives Brian Fitzpatrick (R–PA), Jimmy Panetta (D–CA), John Joyce, MD (R–PA), Paul Tonko (D–NY), Scott Peters (D–CA), and Haley Stevens (D–MI). It would address these challenges by centering reimbursement around each patient’s individualized treatment plan rather than the number of treatments given.
The goals of the ROCR Act follow:
- To protect Americans’ access to high-quality cancer care while generating Medicare savings;
- To align payment incentives with clinical guidelines to reward evidence-based care;
- To support shorter treatments of certain cancers, giving patients more days at home;
- To overcome transportation barriers that keep many patients from finishing treatment.
“Clinical guidelines increasingly favor shorter treatments that improve patients’ quality of life, but the current reimbursement system inadvertently penalizes these advances,” said Dr. Sandler. “Technology and guidelines evolve, yet Medicare’s payment structure remains the same. By passing ROCR, Congress would modernize reimbursement and align payment with best practices in cancer treatment.”
The ROCR Act is broadly supported by nearly 110 organizations. They represent a broad spectrum of oncology stakeholders, including patient advocates, medical professionals, small and large hospital systems, academic centers, independent clinics, and industry.
Prior Authorization and Cancer Research Funding
Radiation oncologists also are asking Congress to support bipartisan legislation that would bring much-needed reform to Medicare Advantage’s broken prior authorization system. Despite promising rulemaking by the Centers and Medicare & Medicaid Services (CMS), ASTRO members consistently report that struggles with benefits management companies are causing unnecessary delays and other problems for their patients.
MORE ABOUT THE ASTRO SURVEY
- A total of 675 physicians responded (16.2% response rate), and respondents were representative of the national ASTRO membership.
- A total of 92% said prior authorization delays their patients from starting cancer treatment, and 68% said these delays last a week or longer.
- One-third said prior authorization has led to adverse events such as hospitalization for their patients, and 85% said the burden has increased in recent years.
Bipartisan federal support for cancer research has contributed to a 34% reduction in cancer mortality, averting nearly four million deaths from cancer in the United States over the past 30 years. Federal funding drives the discovery of new technologies and treatments, including radiation therapy breakthroughs, which improve patients’ survival chances and enhance their quality of life, but this progress relies on sustained investment that grows with inflation.
Investments in cancer research also produce outsized economic benefit; in FY24, the National Institutes of Health (NIH) generated $2.56 in economic activity for every $1 invested in research funding. Radiation oncologists therefore are asking lawmakers for robust federal investment in the research that drives cancer care, specifically through the National Institutes of Health (NIH), the National Cancer Institute (NCI), and the Advanced Research Projects Agency for Health (ARPA-H).
Survey Highlights
Here are some of the highlights from ASTRO’s recent survey, illustrating the dangers to patients and clinics of further Medicare cuts:
- One-third of the physicians in rural areas (32%) and 38% at independent, free-standing centers said another 3% to 5% cut would force them to close, consolidate, leave, or sell their practice.
- Many physicians said another cut will lead to practice downsizing such as reducing staff (65% of respondents) and will make it more difficult to hire and retain staff (86%). The majority (87%) also said another cut would delay or deter upgrades and investments in treatment technologies.
- Two-thirds of the physicians (65%) said more cuts will lead to patients waiting longer for their cancer treatments. Physicians at academic centers and in urban areas, especially, anticipate longer wait times.
