Alternative payment models can stabilize and improve practice radiation reimbursement

Abstract

HEALTH CARE landscape has created a challenging environment for radiation oncologists-one that makes revenue streams unpredictable and increases the administrative hassle associated with the delivery of quality care. Medicare radiation reimbursement rates declined 24% from 2008 to 2017, with an initial 7% to 8% additional payment cut projected for 2022 based on an American Society for Radiation Oncology (ASTRO) analysis of the 2022 Medicare Physician Fee Schedule, 1 which was subsequently mitigated by The Protecting Medicare & American Farmers from Sequester Cuts Act signed in December 2021. 2 Cuts to radiation therapy reimbursement are recommended yearly by CMS. IMPORTANT SAFETY INFORMATION Severe and Fatal Immune-Mediated Adverse Reactions• Immune-mediated adverse reactions, which can be severe or fatal, can occur in any organ system or tissue and can occur at any time during or after treatment with a PD-1/PD-L1-blocking antibody, including JEMPERLI. • Monitor closely for signs and symptoms of immune-mediated adverse reactions. Evaluate liver enzymes, creatinine, and thyroid function tests at baseline and periodically during treatment. For suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate. • Based on the severity of the adverse reaction, withhold or permanently discontinue JEMPERLI. In general, if JEMPERLI requires interruption or discontinuation, administer systemic corticosteroids (1 to 2 mg/kg/day prednisone or equivalent) until improvement to ≤Grade 1. Upon improvement to ≤Grade 1, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reaction is not controlled with corticosteroids.