Caught Between a ROCR and a Hard Place: Improving Proposed Radiation Oncology Alternative Payment Models
Faculty and Abstracts
Purpose: The Radiation Oncology Case Rate (ROCR) aims to shift radiation reimbursement to bundled payments. This study compares historical reimbursement from three large centers with rates from ROCR and incorporates the potential impacts of treatment and disease characteristics.
Methodology: Historical reimbursement from three Mayo Clinic sites were calculated per the ROCR payment methodology. Mean rates for all 15 cancer types were generated. Mayo Clinic rates were stratified by disease and treatment characteristics. Multiple linear regression was performed to assess impact of stratified variables on mean rates.
Results: From Mayo Clinic, 3,498 patient episodes were included. On multivariate analysis, treatment intent (curative vs. palliative) significantly (p ≤ 0.01 for all) increased mean episode rates for bladder (+$6,012), bone metastases (+$2,543), breast (+$5,949), CNS tumors (+$2,170), colorectal cancer (+$7,002), head & neck (+$3,801) lung (+$3,611), lymphoma (+$2,324), pancreatic (+$4,889), upper GI (+$5,811), and uterine (+$7,417). Stage 3-4 vs. stage 1-2 significantly (p ≤ 0.03 for all) increased mean episode rates for bladder (+$3,537), breast (+$4,226), cervical (+$2,496), head & neck (+$1,531), lung (+$1,589), lymphoma (+$1,319), prostate (+$1,995), and upper GI (+$2,000). 25% of brain metastases episodes included ≥2 treatment courses with an average 53 days between courses. Episodes with ≥2 treatment courses increased rates for bone and brain metastases (+$1,640-$1,956; p< 0.01).
Conclusions: Our data suggests that applying a rigid ROCR base rate per cancer type may lead to decreased reimbursement for curative advanced-stage patients and have a disproportionately negative impact on disadvantaged populations in rural areas. A shortened episode duration should be considered for palliative episodes.
