Konski Andre, Yu James B, Freedman Gary, Harrison Louis B, Johnstone Peter A S
Perelman School of Medicine, University of Pennsylvania; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Yale University School of Medicine, New Haven Hospital, New Haven, CT; and Moffitt Cancer Center, Tampa, FL.
Perelman School of Medicine, University of Pennsylvania; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Yale University School of Medicine, New Haven Hospital, New Haven, CT; and Moffitt Cancer Center, Tampa, FL
J Oncol Pract. 2016 May;12(5):e576-83. doi: 10.1200/JOP.2015.007385. Epub 2016 Mar 22.
Use of hypofractionation is increasing in radiation oncology because of several factors. The effects of increasing hypofractionation use on departments and staff currently based on fee-for-service models are not well studied.
We modeled the effects of moving to hypofractionation for prostate, breast, and lung cancer and palliative treatments in a typical-sized hospital-based radiation oncology department. Year 2015 relative value unit (RVU) data were used to determine changes in reimbursement. The change in number of fractions was used to model the effects on machine volume, staff time, and workforce predictions.
The per-case marginal reduction in technical revenue was $1,777, $4,297, $9,041, and $9,498 for palliative and breast, prostate, and lung cancer cases, respectively. The physician reduction per case in RVUs was 5.22, 10.44, 43.02, and 43.02 respectively. A department could anticipate an annual reduction in technical revenue of $540,661 and a reduction in workflow of approximately five patients or 1 to 1.5 hours per day from a hypofractionation rate of 40%.
The move to hypofractionation in the United States will lead to increased pressures on departments to address budget shortfalls resulting from the decrease in per-patient revenue. This may be done through a combination of an increase in patient volume, recognition of the increased skill sets required to deliver hypofractionated radiotherapy, delay in capital purchases, and/or reduction in staff. In a value-based environment, these evolutions should improve the value proposition of radiation oncology over a fee-for-service model.
由于多种因素，在放射肿瘤学中，大分割放疗的使用正在增加。目前基于按服务收费模式，大分割放疗使用增加对科室和工作人员的影响尚未得到充分研究。
我们模拟了一家典型规模的医院放射肿瘤学科室转向前列腺癌、乳腺癌、肺癌大分割放疗及姑息治疗的影响。使用2015年相对价值单位（RVU）数据来确定报销的变化。分次次数的变化用于模拟对机器使用量、工作人员时间和劳动力预测的影响。
姑息治疗、乳腺癌、前列腺癌和肺癌病例每例技术收入的边际减少分别为1777美元、4297美元、9041美元和9498美元。每例医师RVU的减少分别为5.22、10.44、43.02和43.02。一个科室预计技术收入每年减少540,661美元，且大分割放疗率为40%时，工作流程每天减少约5例患者或1至1.5小时。
在美国转向大分割放疗将给科室带来更大压力，以应对因每位患者收入减少导致的预算短缺。这可以通过增加患者数量、认识到提供大分割放疗所需增加的技能、推迟资本采购和/或减少工作人员等多种方式来实现。在基于价值的环境中，这些变化应能改善放射肿瘤学相对于按服务收费模式的价值主张。
