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Impact of Patient Stage and Disease Characteristics on the proposed Radiation Oncology Alternative Payment Model (RO-APM).
International Journal of Radiation Oncology • Biology • Physics ( IF 7 ) Pub Date : 2020-01-28 , DOI: 10.1016/j.ijrobp.2019.12.012
Mark R Waddle 1 , William C Stross 1 , Laura A Vallow 1 , James M Naessens 2 , Launia White 2 , Sarah Meier 2 , Aaron C Spaulding 2 , Steven J Buskirk 1 , Daniel M Trifiletti 1 , Sameer R Keole 3 , Daniel J Ma 4 , Gopal K Bajaj 5 , Nadia N Laack 4 , Robert C Miller 6
Affiliation  

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.

中文翻译:

患者分期和疾病特征对拟议的放射肿瘤学替代支付模型(RO-APM)的影响。

目的2019年7月10日发布的拟议的放射肿瘤学替代支付模型(RO-APM)代表了放射治疗(RT)的服务费(FFS)报销的巨大转变。这项研究将Mayo诊所的历史收益与RO-APM进行了比较,并量化了疾病特征可能对报销的影响。方法和材料从2015年至2016年,在Mayo诊所对接受RT手术的患者确定了FFS医疗保险报销。疾病类别和付款事件根据RO-APM定义。报告了每个疾病部位的平均RT发作报销,淋巴瘤和转移除外,并按阶段和疾病亚类进行了分层。通过描述性统计与RO-APM报销进行了比较。结果共鉴定出2098例患者,其中,RO-APM分类了1866(占89%);其中840(45%)岁的年龄大于65岁。乳腺癌(33%),头颈(HN)(14%)和前列腺癌(11%)最常见。膀胱(-40%),宫颈(-34%),肺(-28%),子宫(-26%),结直肠(-24%)的RO-APM基本费用报销和敏感性分析范围均低于历史报销,肝脏的上消化道(-24%),HN(-23%),胰腺(-20%),前列腺(-16%),中枢神经系统(-13%)和肛门(-10%)及更高(+ 24%)和乳房(+ 36%)。乳腺癌(+ 57%,P <.01),子宫(+ 53%,P = .01),肺(+ 50%,P <.01),HN的历史报销因阶段(III期vs I期)而异(+ 24%,P = 0.01)和前列腺(+ 13%,P = 0.01)。总体而言,对于65岁以上的患者,与历史FFS相比,RO-APM导致总RT报销减少了-9%(调整后的RO-APM率高,中和低分别为-2%,-15%和-27%)。结论我们的研究结果表明RO-APM将导致我们中心的报销大幅减少,尤其是对于服务不足人群中更常见的癌症。照料社会经济上处于不利地位的人群的做法可能面临收入的大幅度减少,这可能进一步减少这一弱势群体的获得机会。
更新日期:2020-03-27
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