Format

Send to

Choose Destination
Int J Radiat Oncol Biol Phys. 2020 Jan 28. pii: S0360-3016(19)34525-0. doi: 10.1016/j.ijrobp.2019.12.012. [Epub ahead of print]

Impact of Patient Stage and Disease Characteristics on the proposed Radiation Oncology Alternative Payment Model (RO-APM).

Author information

1
Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
2
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida.
3
Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
4
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
5
Center for Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, Virginia.
6
Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: RobertMiller@umm.edu.

Abstract

PURPOSE:

The proposed Radiation Oncology Alternative Payment Model (RO-APM) released on July 10, 2019, represents a dramatic shift from fee-for-service (FFS) reimbursement in radiation therapy (RT). This study compares historical revenue at Mayo Clinic to the RO-APM and quantifies the effect that disease characteristics may have on reimbursement.

METHODS AND MATERIALS:

FFS Medicare reimbursements were determined for patients undergoing RT at Mayo Clinic from 2015 to 2016. Disease categories and payment episodes were defined as per the RO-APM. Average RT episode reimbursements were reported for each disease site, except for lymphoma and metastases, and stratified by stage and disease subcategory. Comparisons with RO-APM reimbursements were made via descriptive statistics.

RESULTS:

A total of 2098 patients were identified, of whom 1866 (89%) were categorized per the RO-APM; 840 (45%) of those were aged >65 years. Breast (33%), head and neck (HN) (14%), and prostate (11%) cancer were most common. RO-APM base rate reimbursements and sensitivity analysis range were lower than historical reimbursement for bladder (-40%), cervical (-34%), lung (-28%), uterine (-26%), colorectal (-24%), upper gastrointestinal (-24%), HN (-23%), pancreatic (-20%), prostate (-16%), central nervous system (-13%), and anal (-10%) and higher for liver (+24%) and breast (+36%). Historical reimbursement varied with stage (stage III vs stage I) for breast (+57%, P < .01), uterine (+53%, P = .01), lung (+50%, P < .01), HN (+24%, P = .01), and prostate (+13%, P = .01). Overall, for patients older than 65 years of age, the RO-APM resulted in a -9% reduction in total RT reimbursement compared with historical FFS (-2%, -15%, and -27% for high, mid, and low adjusted RO-APM rates).

CONCLUSIONS:

Our findings indicate that the RO-APM will result in significant reductions in reimbursement at our center, particularly for cancers more common in underserved populations. Practices that care for socioeconomically disadvantaged populations may face significant reductions in revenue, which could further reduce access for this vulnerable population.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center