ASTRO’s 2026 survey data makes the case for episode-based payment, and GammaPod is built for exactly the clinical environment ROCR would create.
New data from the American Society for Radiation Oncology (ASTRO) confirms what radiation oncology practices have been experiencing firsthand: recent Medicare payment changes are harming cancer clinics and threatening patient access to radiation therapy, a critical component of cancer treatment.*
The urgency around the Radiation Oncology Case Rate (ROCR) Act has never been greater.
What the Numbers Show
In March 2026, ASTRO surveyed 160 U.S.-based radiation oncologists about the impact of new Medicare treatment delivery coding changes that took effect at the start of the year. The results are stark. Seventy-six percent of respondents reported a significant negative financial impact, meaning a 10% or greater decline, on facility reimbursement. Sixty-eight percent reported the same level of decline for nonfacility practice revenue. Half reported reductions to personal payroll and bonus compensation.
The administrative toll compounds the financial one. More than half of respondents said their Level 3 cases are frequently downcoded or denied by payers even after appeal. At freestanding centers, that figure rises to 65%. Payer interpretation of code definitions was cited as the primary driver of denials by 92% of respondents, meaning the clinical documentation is not the problem. The system itself is not functioning as intended.
The consequences described by clinicians in the survey are not abstractions. Cancer centers report losing more than $100,000 per month since the coding transition. Practices describe being unable to meet payroll. Physicians describe forgoing their own compensation to keep staff employed. Rural centers that were in development have been put on hold. Community-based clinics, the vital practices that serve patients who cannot easily travel to academic medical centers, are the most exposed.
These are not the conditions under which a broken reimbursement system should be allowed to persist.
What ROCR Does
The Radiation Oncology Case Rate (ROCR) Value-Based Payment Program Act (S.1031 / H.R.2120), reintroduced in March 2025 with bipartisan support, addresses the structural problem directly.
The current Medicare fee-for-service model pays per treatment fraction delivered. This penalizes practices that follow evidence-based guidelines recommending shorter, more intensive courses of radiation therapy, the clinical direction the field has been moving for years. ROCR replaces that model with episode-based payments, compensating providers per patient rather than per visit. The financial incentive shifts from volume to value.
ASTRO has called ROCR “the only viable policy solution designed to provide payment stability for the field of radiation oncology in 2026 and beyond.” More than 110 organizations, spanning patient advocacy groups, hospital systems, independent clinics, medical societies, and medical technology companies, have signed on in support.
The legislation also includes the HEART (Health Equity and Achievement in Radiation Therapy) initiative, which provides funding to help patients in rural and underserved communities overcome the transportation barriers that prevent them from starting and completing treatment.
“ROCR is designed to ensure “patients have access to state-of-the-art care near their homes.”
– Rep. Paul Tonko (NY-20), representing New York’s Capital Region
That phrase, near their homes, matters more than it might appear.
The Proximity Problem, and Why Fewer Fractions Are Part of the Solution
The ASTRO survey data puts numbers to something the GammaPod clinical team has understood from the beginning: when treatment requires 30 or 40 clinic visits, geography becomes a barrier to completing care. Rural patients, patients without reliable transportation, patients with demanding work and caregiving responsibilities, for all of them, a long course of daily radiation therapy is not just inconvenient. For some, it is the reason they do not finish treatment.
Stereotactic radiotherapy, delivering higher doses in one or several large fractions, is not only a clinical advancement. It is a proximity solution. Every fraction eliminated is a trip a patient does not have to make.
GammaPod was designed to bring exactly this capability to early-stage breast cancer, specifically for the patient who has just completed a lumpectomy and is facing weeks of daily radiation visits at a time when she is ready to return to her life. As a dedicated breast radiotherapy system, GammaPod delivers ablative, precisely targeted doses with the patient in a prone, immobilized position, minimizing cardiac and pulmonary dose, in a treatment course that can be completed in a fraction of the visits required by conventional approaches.
The clinical evidence supporting ultra-hypofractionated and radiosurgical approaches to early-stage breast cancer continues to grow, anchored by outcomes data from GammaPod consortium institutions
Under the current fee-for-service reimbursement structure, a practice that treats a patient in fewer fractions collects less revenue than one that treats the same patient over many more visits. The clinical rationale for the shorter course may be unambiguous. The financial structure points the other way. ROCR corrects that misalignment, and in doing so, creates the reimbursement environment in which technologies designed for precision and efficiency can fulfill their clinical promise.
The Path Forward
ASTRO and more than 100 allied organizations have called on Congress to pass the ROCR Act before the end of 2025, a goal the field missed. The urgency is now even more acute. The March 2026 survey data provides Congress with direct, practice-level evidence of the harm the current system is causing. The case for episode-based payment reform has moved from theoretical to documented.
For institutions evaluating dedicated radiotherapy technologies — systems purpose-built for specific cancers, specific patient populations, and shorter, more precise treatment courses, such as Xcision’s GammaPod for early-stage breast cancer — ROCR’s passage matters. And for the patients who would benefit from them, it matters even more. ROCR is the policy architecture that allows clinical innovation to be rewarded rather than penalized.
Xcision and the GammaPod Consortium support the ROCR Act and urge all members of Congress to act. For more information, visit astro.org.
*https://www.astro.org/ASTRO/media/ASTRO/News%20and%20Publications/PDFs/ExecutiveSummary_ASTRO_Survey_2026CodingChanges.pdf