Radiation oncology has traditionally been paid fee-for-service, which rewards volume more than value. In this business plan, Nadeem Khan, MS, DHA, DABR, FACRO, FAHM, FHIAS, FACMPE, lays out how a large independent, physician-owned oncology group could shift toward bundled payments: a predetermined payment for an episode of radiation treatment, set by disease site or treatment modality and tied to quality metrics.

The plan covers:

• Organization: SWOT analyses of the current and proposed business, a task force to lead payer negotiations and a three-year timeline that starts with one commercial payer on a one- to two-year contract
• Marketing: promoting bundles to referring physicians, a joint-venture partner, mid-sized businesses through direct contracting, and self-insured employers and individuals
• Finances: a three-year projection, built on assumed volume growth, staff consolidation and a 10% lower bundled price, that shows a first-year revenue shortfall against the group's current model, recovered by the third year

The author argues that bundles can benefit payers, providers and patients through predictable costs, less preauthorization work and support for shorter, hypofractionated treatment courses. Although the plan is specific to radiation oncology, its steps for preparing to negotiate bundled contracts may interest leaders in other specialties.

About ACMPE Fellowship papers

Fellowship (FACMPE) is the highest designation offered by the American College of Medical Practice Executives (ACMPE). Fellowship candidates wrote papers like this one to show command of a practice management topic through original research or a detailed business plan.

About this content

This paper was written in 2021 and has not been updated. It anticipates a CMS Radiation Oncology Model then expected to begin in January 2022; that model was delayed and, in 2022, postponed indefinitely. Reimbursement and payer contracting have also changed since then, so check figures and requirements against current sources before acting on them.