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Episode-Based Payment Model Shortens Radiotherapy Courses But Reduces Reimbursements

November 28, 2020

The Radiation Oncology Alternative Payment Model (RO-APM) encourages shorter courses of radiotherapy, but emerging technologies with large capital and operating investment needs may see reductions in reimbursements, according to a recent study in JCO Oncology Practice (2020. doi:10.1200/OP.20.00495).

“An episode-based payment model, the [RO-APM], has been proposed for Medicare reimbursement of radiation services provided to oncology patients,” wrote Sanford Meeks, PhD, Department of Radiation Oncology, Orlando Health UF Health Cancer Center (Orlando, FL) and colleagues.

Researchers investigated fee-for-service technical reimbursement estimates at a large hospital-based system in comparison with the RO-APM for advanced radiotherapy treatment of specific cancer types. Radiation oncology procedures such as stereotactic radiosurgery (SRS), stereotactic body radiotherapy (SBRT), online-adaptive SBRT, and proton therapy were chosen because they are resource intensive and the most expensive procedures.

The results showed similar RO-APM base-rate reimbursements for SRS but 38% to 47% higher for SBRT, 1% to 31% lower for online-adaptive SBRT, and 48% to 71% lower for proton therapy.

“These data suggest that the RO-APM may have the desired effect of encouraging shorter courses of radiotherapy, such as SBRT,” concluded Dr Meeks and colleagues. “However, emerging technologies that require large capital and operating investments may see an overall significant reduction in proposed reimbursement.”—Lisa Kuhns

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