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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...

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Autores principales: Palm, Russell F., Eicher, Kurt G., Sim, Austin J., Peneguy, Susan, Rosenberg, Stephen A., Wasserman, Stuart, Johnstone, Peter A. S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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