Stifling Innovation: Proton Therapy Should Be Excluded From the New Radiation Oncology Alternative Payment Model

2021 ◽  
Keyword(s):  
Proton Therapy ◽  
Radiation Oncology ◽  
Payment Model

Effect of Proposed Episode-Based Payment Models on Advanced Radiotherapy Procedures

2020 ◽  
pp. OP.20.00495
Author(s):  
Sanford L. Meeks ◽  
Amish P. Shah ◽  
Gaurav Sood ◽  
Tomas Dvorak ◽  
Omar A. Zeidan ◽  
...  
Keyword(s):  
Proton Therapy ◽  
Radiation Oncology ◽  
Fee For Service ◽  
Medicare Reimbursement ◽  
Large Hospital ◽  
Specific Patient ◽  
Payment Model ◽  
Medicare Patients ◽  
Cancer Types ◽  
Radiotherapy Treatment

PURPOSE: An episode-based payment model, the Radiation Oncology Alternative Payment Model (RO-APM), has been proposed for Medicare reimbursement of radiation services provided to oncology patients. RO-APM may have significant impact on reimbursement for specific patient populations. METHODS: This investigation compares historical fee-for-service technical reimbursement estimates at a large hospital-based system to the RO-APM for advanced radiotherapy treatment of specific cancer types. These advanced techniques, stereotactic radiosurgery (SRS), stereotactic body radiotherapy (SBRT), online-adaptive SBRT, and proton therapy, were specifically chosen because they are resource intensive and are correspondingly among the most expensive radiation oncology procedures. A total of 203 Medicare patients were analyzed. RESULTS: RO-APM base-rate reimbursements were similar for SRS and were 38%-47% higher for SBRT. The proposed rates were 1%-31% lower for online-adaptive SBRT, and 48%-71% lower for proton therapy. CONCLUSION: These data suggest that the RO-APM may have the desired effect of encouraging shorter courses of radiotherapy, such as SBRT. However, emerging technologies that require large capital and operating investments may see an overall significant reduction in proposed reimbursement.

scholarly journals Long-term outcomes of proton therapy for prostate cancer in Japan: a multi-institutional survey of the Japanese Radiation Oncology Study Group

2018 ◽  
Vol 7 (3) ◽  
pp. 677-689 ◽  
Author(s):  
Hiromitsu Iwata ◽  
Hitoshi Ishikawa ◽  
Masaru Takagi ◽  
Tomoaki Okimoto ◽  
Sigeyuki Murayama ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Proton Therapy ◽  
Radiation Oncology ◽  
Study Group ◽  
Long Term Outcomes

Disproportionate Negative Impact of the Radiation Oncology Alternative Payment Model on Rural Providers: A Cost Identification Analysis of Medicare Claims

2021 ◽  
pp. OP.21.00330
Author(s):  
Constantine A. Mantz ◽  
Nikhil G. Thaker ◽  
Praveen Pendyala ◽  
Anne Hubbard ◽  
Thomas J. Eichler ◽  
...  
Keyword(s):  
Radiation Oncology ◽  
Negative Impact ◽  
Quality Care ◽  
Fee For Service ◽  
Current Form ◽  
Payment Model ◽  
Physician Practices ◽  
Bundled Payments ◽  
Treatment Services ◽  
Rural And Urban

PURPOSE: The Radiation Oncology Alternative Payment Model (APM) is a Medicare demonstration project that will test whether prospective bundled payments to a randomly selected group of physician practices, hospital outpatient departments, and freestanding radiation therapy centers reduce overall expenditures while preserving or enhancing the quality of care for beneficiaries. The Model follows a complicated pricing methodology that blends historical reimbursements for a defined set of services made to professional and technical providers to create a weighted payment average for each of 16 cancer types. These averages are then adjusted by various factors to determine APM payments specific to each participating provider. METHODS: This impact study segregates APM participants into rural and urban groups and analyzes the effect of the Radiation Oncology Alternative Payment Model on their fee-for-service reimbursements. RESULTS: The main findings of this study are (1) the greater net-negative revenue impact on rural facilities versus urban facilities that would have participated in the Model this year and (2) the relative lack of high-value treatment services (ie, stereotactic radiotherapy and brachytherapy) delivered by rural facilities that exacerbates their negative impact. CONCLUSION: As such, rural providers participating in the Model in its current form may face greater risk to their economic viability and greater difficulty in funding technology improvements necessary for the achievement of high-quality care compared with their urban counterparts.

Impact of the Radiation Oncology Alternative Payment Model on Brachytherapy Reimbursement

Brachytherapy ◽  
2021 ◽  
Author(s):  
Nikhil G. Thaker ◽  
Rehman Meghani ◽  
Cassandra Wilson ◽  
Jody Garey ◽  
Philip Nelson ◽  
...  
Keyword(s):  
Radiation Oncology ◽  
Payment Model

Automated Big Data Analytics for the Radiation Oncology Alternative Payment Model Proposal Using a Novel Health Care Software Technology

2020 ◽  
Vol 16 (4) ◽  
pp. e333-e340 ◽  
Author(s):  
Nikhil G. Thaker ◽  
Joshua Holloway ◽  
Chas Hodapp ◽  
Michael Mellen ◽  
David Fryefield ◽  
...  
Keyword(s):  
Radiation Oncology ◽  
Big Data Analytics ◽  
Large Network ◽  
Treatment Delivery ◽  
Payment Model ◽  
Community Oncology ◽  
Historical Episode ◽  
Uterine Cancers ◽  
Automated Software ◽  
Clinical Rules

INTRODUCTION: The proposed Radiation Oncology Alternative Payment Model (RO-APM) aims to test prospective episode-based payments for radiotherapy episodes. Practices will need a tool that can calculate historical episode reimbursements to succeed in this new model. An automated software-based technology was created to calculate historical episode reimbursements within a large Network of community oncology practices. MATERIALS AND METHODS: Claims data between January 1, 2017, and July 31, 2019, were cleaned, organized into episodes, and analyzed with a series of Python computer programs per proposed RO-APM methodology. Averaged Winsorized historical episode reimbursements were first calculated over the entire Network, then over 24 of the largest Practices, and then rerun after application of Clinical Rules to remove misattributed episodes. RESULTS: A total of 79,418 RO-APM–defined episodes were generated from 6,512,375 claims lines. A total of 7,086 episodes (8.9%) were removed because of no treatment delivery code within 28 days of treatment planning. The Network of practices had more bone metastases, and breast, cervical, and uterine cancers but less lung and prostate cancer than the RO-APM dataset. Combination-modality episodes were more costly and required more providers than single-modality episodes. Clinical Rules reattributed 2,495 episodes (3.4%) and increased episode reimbursement by +5.8% over all disease sites (+3.7% using volume weighting; P = .001). CONCLUSION: As payment models continue to shift from volume to value, practices will need an automated analytics technology to measure historical costs and prepare for operational and financial transformation. This automated approach can be adapted to future versions of the RO-APM. Our analysis suggests that future iterations of the RO-APM could incorporate Clinical Rules to remove misattributed palliative care episodes and could implement a separate payment for episodes with multiple radiation therapy modalities.

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