Radiation Oncology Benefit Management companies (ROBMs) have entered the health care marketplace to manage private insurer payments to providers for radiation therapy services, including intensity-modulated radiation therapy (IMRT) and proton beam therapy. Through their proprietary medical policies and authorization procedures, ROBMs assist insurers in evaluating and approving prescribed radiation treatment courses as a condition of payment to the provider.
ASTRO endorses professionally developed and vetted clinical practice guidelines, appropriateness of care criteria and consensus-based model policies developed in a transparent manner with peer review and input as the foundation for clinical decision making. ASTRO opposes restrictive practice guidelines that oversimplify the process of individual patient management and abrogate the professional judgments that are often only possible within the private boundaries of a direct patient-doctor relationship. Additionally, ASTRO joined a work group composed of specialty medical societies, national provider associations and patient representatives. The work group identified 21 principles to address and improve categories of concern.
In recent months, ASTRO has received complaints regarding ROBMs due to increases in denials and delays in preauthorization, treatment or payment. These activities have often caused distressing delays in care for cancer patients, as well as increased costs for providers and their practice staff who must navigate tedious authorization processes. ASTRO members have shared specific accounts of delays in treatment and payment and inadequate peer-to-peer reviews of contested cases.
ASTRO has developed a form for members experiencing issues with ROBMs to complete. Your examples will provide us with specific barriers to care that we hope to resolve. Please complete the form and share your experience with us to help us address these issues. These concrete examples will demonstrate to ROBMs, and the payers who employ their services, how these practices disrupt all phases of patient care. Also, please feel free to let us know of any improvements you would like to see in the form itself. You may also visit our website to learn more about ROBMs.
Constantine Mantz is chief medical officer, 21st Century Oncology, Inc. He is the Chair of the ASTRO Payer Relations Subcommittee.