March 14, 2025 — Another pivotal milestone in the nation’s fight against cancer recently took place with the reintroduction of bipartisan federal legislation to transform Medicare reimbursement for radiation therapy.
The Radiation Oncology Case Rate (ROCR) Value Based Payment Program Act of 2025, sponsored by Sens. Thom Tillis (R-N.C.) and Gary Peters (D-Mich.) and Reps. Brian Fitzpatrick (R-Pa.), Jimmy Panetta (D-Calif.), John Joyce, MD (R-Pa.) and Paul Tonko (D-N.Y.), would protect access to high quality cancer care and improve outcomes for patients nationwide, while generating savings for Medicare.
The ROCR Act provides a patient-centered solution to modernize how Medicare reimburses radiation therapy services. By shifting away from the current quantity-based, per-treatment system to patient-focused, episode-based payments, ROCR prioritizes the quality and value of care provided — rather than the number of treatment visits. Passage of the ROCR Act would serve as an example of bipartisan congressional action toward value-based payment policy for America’s health care system.
“The ROCR Act represents a balanced, evidence-based policy solution to safeguard access to high value cancer treatment for Americans, and it is the only viable policy solution designed to provide payment stability for the field of radiation oncology in 2026 and beyond,” said Howard M. Sandler, MD, FASTRO, Chair of the American Society for Radiation Oncology (ASTRO) Board of Directors. “ASTRO applauds Sen. Tillis, Sen. Peters, Rep. Fitzpatrick, Rep. Panetta, Rep. Joyce and Rep. Tonko for championing a forward-thinking, patient-centered policy that keeps quality and value at the heart of cancer care.”
ROCR is broadly supported by more than 80 organizations representing a wide spectrum of radiation oncology stakeholders, including patient advocates, health professionals, small and large hospital systems, independent clinics and technology companies. Its introduction follows years of diminishing returns in the radiation oncology reimbursement landscape, marked by declining Medicare payments — with cuts totaling more than 25% since 2013 — as well as rising practice costs and an increase in the number of Americans needing cancer treatments. A recent study found that these and other factors have contributed to practice consolidation, with a 51% increase in large practices and 27% decrease in solo practices between 2015 and 2023.
Key features of the ROCR Act of 2025 include:
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Patient specific episode-based payments that align financial incentives with guideline-driven care supported by science
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Encouraging the adoption of evidence-based shorter treatments when they are clinically determined to be in the patient's best interest, minimizing physical and financial burdens on patients
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Strengthening quality and safety standards by incentivizing practice accreditation and supporting new technologies for patient care
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Targeted support to tackle transportation barriers that keep patients from completing their radiation treatments
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Unifying technical payments across hospital and freestanding/community practice settings
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Generating millions of dollars in Medicare savings while ensuring that more than a million Americans who receive radiation therapy for cancer each year maintain access to the best possible treatment
“The ROCR Act modernizes Medicare’s payment system to ensure cancer patients receive the best care possible,” said Sen. Tillis. “Current reimbursement policies reward quantity over quality, making it harder for physicians to provide the tailored, high-quality care cancer patients deserve. This bipartisan bill fixes this by shifting to a fair, bundled payment model that removes incentives for longer treatments, supports innovation, and ensures continued access to world-class care.”
“Radiation oncology is a highly effective tool for fighting certain cancers, but outdated Medicare reimbursement policies prevent many Americans from being able to utilize this treatment,” said Sen. Peters. “I’m proud to help lead this bipartisan bill that would reduce barriers to this essential care for cancer patients and ensure oncologists can prescribe the best treatment available for their patients.”
ROCR builds on lessons learned from the indefinitely delayed Medicare Radiation Oncology Alternative Payment Model (RO Model), which offered changes but failed to adequately address stakeholders’ concerns. The bipartisan ROCR bill incorporates the RO Model’s strengths, namely the use of episode-based payments to support patient-centric care, while addressing shortcomings such as mandated cuts and burdensome reporting requirements. ROCR was introduced last year in the previous Congress by Sen. Tillis and Reps. Fitzpatrick, Panetta, Joyce and Tonko, with 10 additional members of Congress joining as cosponsors.
ASTRO urges all members of Congress to support this bill and help usher in a new era of evidence-backed, bipartisan policy solutions to safeguard Americans’ access to high quality, high value cancer treatment in their communities.
July 30, 2024 
