Drivers of Medicare Spending: A 15-Year Review of Radiation Oncology Charges Allowed by the Medicare Physician/Supplier Fee-for-Service Program Compared With Other Specialties

Mokhtech, Meriem; Laird, J.H.; Maroongroge, Sean; Zhu, Diana; Falit, Benjamin P.; Johnstone, Peter A.S.; Mantz, C.A.; Ennis, Ronald D.; Sandler, Howard M.; Dosoretz, Arie P.; Yu, James B.

doi:10.1016/j.ijrobp.2020.12.051

Cited by 8 publications

(2 citation statements)

References 9 publications

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“…Another key weakness of the RO-APM is that financial risk factors such as advanced age and disease stage are not considered and centers that care for these patients may be further disadvantaged by the RO-APM [39]. Furthermore, radiation oncology accounted for 1.4% of total Medicare charges in 2017 and is hundreds of millions of dollars lower than diagnostic radiology (3.8%) and medical oncology (6.6%) [40] for whom a specific driver of increased cost is metastatic disease [41,42]. In an analysis of commercial payments for breast, colorectal and lung cancer patients, radiation therapy and imaging accounted for less than 15% of the total cost of care while chemotherapy and supportive drug therapies accounted for 48% [42].…”

Section: Discussionmentioning

confidence: 99%

Assessment of MRI-Linac Economics under the RO-APM

Palm

Eicher²,

Sim

et al. 2021

JCM

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The implementation of the radiation oncology alternative payment model (RO-APM) has raised concerns regarding the development of MRI-guided adaptive radiotherapy (MRgART). We sought to compare technical fee reimbursement under Fee-For-Service (FFS) to the proposed RO-APM for a typical MRI-Linac (MRL) patient load and distribution of 200 patients. In an exploratory aim, a modifier was added to the RO-APM (mRO-APM) to account for the resources necessary to provide this care. Traditional Medicare FFS reimbursement rates were compared to the diagnosis-based reimbursement in the RO-APM. Reimbursement for all selected diagnoses were lower in the RO-APM compared to FFS, with the largest differences in the adaptive treatments for lung cancer (−89%) and pancreatic cancer (−83%). The total annual reimbursement discrepancy amounted to −78%. Without implementation of adaptive replanning there was no difference in reimbursement in breast, colorectal and prostate cancer between RO-APM and mRO-APM. Accommodating online adaptive treatments in the mRO-APM would result in a reimbursement difference from the FFS model of −47% for lung cancer and −46% for pancreatic cancer, mitigating the overall annual reimbursement difference to −54%. Even with adjustment, the implementation of MRgART as a new treatment strategy is susceptible under the RO-APM.

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Section: Discussionmentioning

confidence: 99%

Assessment of MRI-Linac Economics under the RO-APM

Palm

Eicher²,

Sim

et al. 2021

JCM

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“…In an effort to protect patients' access to high-quality cancer care and avoid the characteristic payment instability of the FFS system, the radiation oncology community proactively engaged CMMI on the development of a radiation oncology–specific alternative payment model. Although representing only 1.6% of total Medicare expenditures in 2012, radiation oncology came under the radar of CMS because of the 44% increase in radiation oncology–related Medicare charges from 2002 to 2012 ($987.6 million US dollars [USD] to $1.42 billion USD), 11 driven in part based on the volume-based incentives and billing complexity unique to radiation oncology. 12,13 In 2015, the patient access and Medicare protection act required CMMI to submit a report to the Congress on the development of an RO-APM.…”

Section: Ro-apm: Background and Overviewmentioning

confidence: 99%

Radiation Oncology Alternative Payment Model and Large Urban Academic Centers: Future Implications for Patients and Providers

Pendyala

Goglia

Young

et al. 2021

JCO Oncology Practice

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The radiation oncology alternative payment model (RO-APM) was developed by the Center for Medicare and Medicaid Innovation, a part of the Centers for Medicare & Medicaid Services, as a vehicle to optimize value for patients undergoing radiation therapy. By shifting reimbursement away from fee-for-service and toward a prospective bundled payment system, the RO-APM is intended to bend the cost curve in radiation oncology while preserving or even enhancing outcomes. As with prior large-scale policy initiatives, the nature and magnitude of the RO-APM's impact on care delivery will vary substantially depending on a host of local factors, including practice setting. Urban academic centers play a key role in radiation oncology by spearheading innovation, managing the most complicated cases, training the next generation of radiation oncologists, and often caring for vulnerable patient populations. Thus, to protect patients' access to this high-quality cancer care, it will be crucial to characterize the RO-APM's projected impact on large urban academic institutions before its implementation, including possible unintended adverse consequences. Here, we provide an overview of this seismic change in radiation oncology reimbursement and discuss its unique potential implications for large urban academic institutions as a means to facilitate necessary preparations and inform future revisions to the model.

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The Economics of Particle Therapy

Waddle¹,

Miller²

2022

Principles and Practice of Particle Therapy

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Drivers of Medicare Spending: A 15-Year Review of Radiation Oncology Charges Allowed by the Medicare Physician/Supplier Fee-for-Service Program Compared With Other Specialties

Cited by 8 publications

References 9 publications

Assessment of MRI-Linac Economics under the RO-APM

Assessment of MRI-Linac Economics under the RO-APM

Radiation Oncology Alternative Payment Model and Large Urban Academic Centers: Future Implications for Patients and Providers

The Economics of Particle Therapy

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