Bauer-Nilsen Kristine, Hill Colin, Trifiletti Daniel M, Libby Bruce, Lash Donna H, Lain Melody, Christodoulou Deborah, Hodge Constance, Showalter Timothy N
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia.
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia.
Int J Radiat Oncol Biol Phys. 2018 Jan 1;100(1):88-94. doi: 10.1016/j.ijrobp.2017.09.004. Epub 2017 Sep 14.
To evaluate the delivery costs, using time-driven activity-based costing, and reimbursement for definitive radiation therapy for locally advanced cervical cancer.
Process maps were created to represent each step of the radiation treatment process and included personnel, equipment, and consumable supplies used to deliver care. Personnel were interviewed to estimate time involved to deliver care. Salary data, equipment purchasing information, and facilities costs were also obtained. We defined the capacity cost rate (CCR) for each resource and then calculated the total cost of patient care according to CCR and time for each resource. Costs were compared with 2016 Medicare reimbursement and relative value units (RVUs).
The total cost of radiation therapy for cervical cancer was $12,861.68, with personnel costs constituting 49.8%. Brachytherapy cost $8610.68 (66.9% of total) and consumed 423 minutes of attending radiation oncologist time (80.0% of total). External beam radiation therapy cost $4055.01 (31.5% of total). Personnel costs were higher for brachytherapy than for the sum of simulation and external beam radiation therapy delivery ($4798.73 vs $1404.72). A full radiation therapy course provides radiation oncologists 149.77 RVUs with intensity modulated radiation therapy or 135.90 RVUs with 3-dimensional conformal radiation therapy, with total reimbursement of $23,321.71 and $16,071.90, respectively. Attending time per RVU is approximately 4-fold higher for brachytherapy (5.68 minutes) than 3-dimensional conformal radiation therapy (1.63 minutes) or intensity modulated radiation therapy (1.32 minutes).
Time-driven activity-based costing was used to calculate the total cost of definitive radiation therapy for cervical cancer, revealing that brachytherapy delivery and personnel resources constituted the majority of costs. However, current reimbursement policy does not reflect the increased attending physician effort and delivery costs of brachytherapy. We hypothesize that the significant discrepancy between treatment costs and physician effort versus reimbursement may be a potential driver of reported national trends toward poor compliance with brachytherapy, and we suggest re-evaluation of payment policies to incentivize quality care.
采用时间驱动作业成本法评估局部晚期宫颈癌根治性放射治疗的交付成本及报销情况。
创建流程图以表示放射治疗过程的每个步骤，包括提供护理所使用的人员、设备和耗材。对人员进行访谈以估计提供护理所需的时间。还获取了薪资数据﹑设备采购信息和设施成本。我们定义了每种资源的产能成本率（CCR），然后根据CCR和每种资源的使用时间计算患者护理的总成本。将成本与2叭6年医疗保险报销金额和相对价值单位（RVU）进行比较。
宫颈癌放射治疗的总成本为12861.68美元，其中人员成本占49.8%。近距离放射治疗成本为8610.68美元（占总成本的66.9%），占用放射肿瘤学主治医生423分钟的时间（占总时间的80.0%）。外照射放射治疗成本为4055.01美元（占总成本的31.5%）。近距离放射治疗的人员成本高于模拟和外照射放射治疗交付成本之和（4798.73美元对1404.72美元）。一个完整的放射治疗疗程为放射肿瘤学主治医生提供149.77个强度调制放射治疗相对价值单位或135.90个三维适形放射治疗相对价值单位，报销总额分别为２3321.71美元和16071.90美元。近距离放射治疗每个相对价值单位的主治医生时间（5.68分钟）约为三维适形放射治疗（1.63分钟）或强度调制放射治疗（1.32分钟）的4倍。
采用时间驱动作业成本法计算宫颈癌根治性放射治疗的总成本，结果显示近距离放射治疗的交付和人员资源占成本的大部分。然而，目前的报销政策并未反映出近距离放射治疗中主治医生付出的更多努力和交付成本。我们推测，治疗成本和医生努力程度与报销之间的显著差异可能是全国范围内报道的近距离放射治疗依从性差趋势的一个潜在驱动因素，我们建议重新评估支付政策以激励优质护理。
