Radiation Oncology Payment Models – Are they data-driven?
Faculty and Abstracts
Purpose: The field of radiation oncology (RO) has had many changing landscapes in the past few decades. From technology innovations to hypofractionation trends, there have been many changes in the way that radiation therapy is delivered. One of the hot-topic possibilities on the horizon is a change in the way that radiation services are paid for by government insurance providers. An alternative payment model, the RO-APM, was proposed by the Centers for Medicare and Medicaid and ultimately delayed and defeated. [1,2] Subsequently ASTRO has proposed a new alternative payment model called ROCR (Radiation Oncology Case Rate Program), with the main goals of changing RO payments from a per fraction basis to a per patient basis and to stabilize payments for RO services in the coming years amid an onslaught of cuts to outpatient services in recent years by congressional leaders. [3] The announcement of ROCR largely came as a surprise to most of the RO community, and it raised several important questions for consideration, including whether the ROCR model is data-driven and would meet future needs for payment reform for our field, particularly in light of the challenging reimbursement processes of newer plans such as Medicare Advantage. However, some form of alternative payment model for RO may be essential to avoiding devaluation of reimbursement codes in the future. Our team therefore seeks to investigate how data-driven current and future proposed payment models are for radiation oncology.
Methodology: Proposed methods include a thorough examination of publicly available Medicare claims to establish trends of RO payments over the past decade, as well as focus groups with key stakeholders in RO economics and revenue systems to better understand the current landscape of payment models and proposed models. The 15 common cancer types that are included proposed APM models will be reviewed in patients treated with conventional, IMRT, SRS, and SBRT external beam modalities using protons, photons, and electrons. Specific demographics that will be examined include race, gender, and site of service considerations (rural vs metropolitan vs urban as well as free-standing centers vs hospitals). The time period examined will include available data in the past decade pre-pandemic (2009 – 2019) in order to capture modern trends in RO treatments delivered.
Results: Forthcoming
Conclusions: The first step in creating any meaningful change is establishing an awareness of the current issues at hand, and then identifying problems and potential solutions can follow. This work will evaluate the nature of current issues with payment models for RO and identify key areas where there are needs for payment reform, including specific insurance providers that pose the greatest risk for continuing to provide high quality, guideline-concordant care for patients.
