Radiation Oncology Practice: Adjusting to a New Reimbursement Model

Konski, André; Yu, James B.; Freedman, Gary M.; Harrison, Louis B.; Johnstone, Peter A.S.

doi:10.1200/jop.2015.007385

Cited by 31 publications

(33 citation statements)

References 28 publications

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“…In 2010, 64% of radiation oncologists in the United States had access to equipment sufficient for the application of hypofractionation techniques. Research suggests that uptake of hypofractionation across the United States in 2011 was observed in 8% of prostate cancer patients, 44% of inoperable lung cancer patients and 20–35% in the setting of breast cancer . In contrast, the uptake figures across Canadian breast cancer patients is currently estimated at 70%; perhaps reflecting differences in practice attributed to varying models of health care.…”

Section: Discussionmentioning

confidence: 99%

“…There is considerable evidence to support the use of hypofractionation in the setting of lung cancer and palliation. Extreme hypofractionated regimens for lung cancer offer favourable outcomes with a cost‐effective and less invasive procedure than surgery and associated hospitalisation . Furthermore, multiple studies across Europe and the USA have demonstrated an equivalent outcome in hypofractionated palliation compared with conventional approaches – though this technique is heavily underutilised …”

Section: Discussionmentioning

confidence: 99%

“…However, on cost alone, symptom management represents a small part (<10%) of the average total cost for patients who develop grade 2/3 bowel or urinary toxicity . In contrast, additional studies have demonstrated that hypofractionation is effective in the management of prostate cancer, with attributed health gains …”

Section: Discussionmentioning

confidence: 99%

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Cost‐containment in hypofractionated radiation therapy: a literature review

Hunter

Mauldon

Anderson

2018

J of Medical Radiation Sci

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Recent technological advances in radiation therapy have allowed for greater accuracy in planning and treatment delivery. The development of hypofractionated radiation treatment regimens is an example, and has the potential to decrease the cost per episode of care, relative to conventional treatments. Our aim was to analyse published literature on the cost‐effectiveness and budgetary implications of hypofractionated radiation therapy. As such, this article will quantify the projected health care cost savings and address the optimal means of treatment delivery, associated patient outcomes, and implications arising from an increased use of hypofractionated regimens.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cost‐containment in hypofractionated radiation therapy: a literature review

Hunter

Mauldon

Anderson

2018

J of Medical Radiation Sci

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“…The current fee-forservice reimbursement paradigm in radiation oncology misaligns incentives by rewarding longer courses of radiation. Konksi et al (52) showed that if a radiation therapy department treated 40% of its breast cancer patients with hypofractionated therapy, annual revenue would decrease by over $500,000. Alternate reimbursement models that incentivize greater adherence to evidence-based recommendations could help reduce both physician-based and practice-based variability while improving quality of care.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer

Boero

Gillespie

Hou

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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SummaryThis study evaluated the impact of radiation oncologists on the early adoption of hypofractionated radiation therapy for early-stage breast cancer. Using SEERMedicare data and multilevel, multivariable logistic models, we assessed the impact of radiation oncologist and geographic practice area on the likelihood of receiving hypofractionated radiation therapy. The key finding of our study was that the individual radiation oncologist heavily influenced the decision to pursue hypofractionation.Purpose: Despite multiple randomized trials showing the efficacy of hypofractionated radiation therapy in early-stage breast cancer, the United States has been slow to adopt this treatment. The goal of this study was to evaluate the impact of individual radiation oncologists on the early adoption of hypofractionated radiation therapy for early-stage breast cancer. Methods: We identified 22,233 Medicare beneficiaries with localized breast cancer that was diagnosed from 2004 to 2011 who underwent breast-conserving surgery with adjuvant radiation. Multilevel, multivariable logistic models clustered by radiation oncologist and geographic practice area were used to determine the impact of the provider and geographic region on the likelihood of receiving hypofractionated compared with standard fractionated radiation therapy while controlling for a patient's clinical and demographic covariates. Odds ratios (OR) describe the impact of demographic or clinical covariates, and the median OR (MOR) describes the relative impact of the individual radiation oncologist and geographic region on the likelihood of undergoing hypofractionated radiation therapy. Results: Among the entire cohort, 2333 women (10.4%) were treated with hypofractionated radiation therapy, with unadjusted rates ranging from 0.0% in the bottom quintile of radiation oncologists to 30.4% in the top quintile. Multivariable analysis found that the individual radiation oncologist (MOR 3.08) had a greater impact on the use of hypofractionation than did geographic region (MOR 2. Radiation OncologyInternational Journal of biology physics www.redjournal.org long-term randomized trial results in early 2010. Male physician and radiation oncologists treating the highest volume of breast cancer patients were less likely to perform hypofractionation (P<.05). Conclusions: The individual radiation oncologist strongly influenced the likelihood of a patient's receiving hypofractionated radiation therapy, and this trend increased despite the publication of long-term data showing equivalence to standard fractionation. Future research should focus on physician-related factors that influence this decision. Ó

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“…The UK and Canada have seen far broader adoption of HF-WBI (around 80% and 71%, respectively) (18,19), which can in part be attributed to the UK’s nationalized adoption of HF-WBI and Canada’s more flexible use of fee-for-service payments. It is estimated that a US hospital-based practice’s adoption of a 70% HF-WBI rate would result in annual reductions of $300,790 in technical revenues and 731 professional RVUs with current reimbursement policies (20), representing significant proportions of total practice income; therefore, it is not surprising that variation in HF-WBI utilization has been found to be related more to individual provider characteristics than clinical or demographic characteristics (21). …”

mentioning

confidence: 99%