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Assessment of MRI-Linac Economics under the RO-APM
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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8539760/ https://www.ncbi.nlm.nih.gov/pubmed/34682829 http://dx.doi.org/10.3390/jcm10204706 |
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author | Palm, Russell F. Eicher, Kurt G. Sim, Austin J. Peneguy, Susan Rosenberg, Stephen A. Wasserman, Stuart Johnstone, Peter A. S. |
author_facet | Palm, Russell F. Eicher, Kurt G. Sim, Austin J. Peneguy, Susan Rosenberg, Stephen A. Wasserman, Stuart Johnstone, Peter A. S. |
author_sort | Palm, Russell F. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8539760 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-85397602021-10-24 Assessment of MRI-Linac Economics under the RO-APM Palm, Russell F. Eicher, Kurt G. Sim, Austin J. Peneguy, Susan Rosenberg, Stephen A. Wasserman, Stuart Johnstone, Peter A. S. J Clin Med Article 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. MDPI 2021-10-14 /pmc/articles/PMC8539760/ /pubmed/34682829 http://dx.doi.org/10.3390/jcm10204706 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Palm, Russell F. Eicher, Kurt G. Sim, Austin J. Peneguy, Susan Rosenberg, Stephen A. Wasserman, Stuart Johnstone, Peter A. S. Assessment of MRI-Linac Economics under the RO-APM |
title | Assessment of MRI-Linac Economics under the RO-APM |
title_full | Assessment of MRI-Linac Economics under the RO-APM |
title_fullStr | Assessment of MRI-Linac Economics under the RO-APM |
title_full_unstemmed | Assessment of MRI-Linac Economics under the RO-APM |
title_short | Assessment of MRI-Linac Economics under the RO-APM |
title_sort | assessment of mri-linac economics under the ro-apm |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8539760/ https://www.ncbi.nlm.nih.gov/pubmed/34682829 http://dx.doi.org/10.3390/jcm10204706 |
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