Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
JCO Oncol Pract. 2021 Dec;17(12):e1968-e1976. doi: 10.1200/OP.21.00347. Epub 2021 Oct 22.
The radiation oncology alternative payment model (RO-APM) was developed by the Center for Medicare and Medicaid Innovation, a part of the Centers for Medicare & Medicaid Services, as a vehicle to optimize value for patients undergoing radiation therapy. By shifting reimbursement away from fee-for-service and toward a prospective bundled payment system, the RO-APM is intended to bend the cost curve in radiation oncology while preserving or even enhancing outcomes. As with prior large-scale policy initiatives, the nature and magnitude of the RO-APM's impact on care delivery will vary substantially depending on a host of local factors, including practice setting. Urban academic centers play a key role in radiation oncology by spearheading innovation, managing the most complicated cases, training the next generation of radiation oncologists, and often caring for vulnerable patient populations. Thus, to protect patients' access to this high-quality cancer care, it will be crucial to characterize the RO-APM's projected impact on large urban academic institutions before its implementation, including possible unintended adverse consequences. Here, we provide an overview of this seismic change in radiation oncology reimbursement and discuss its unique potential implications for large urban academic institutions as a means to facilitate necessary preparations and inform future revisions to the model.
放射肿瘤学替代支付模式(RO-APM)由医疗保险和医疗补助服务中心的一部分——医疗保险和医疗补助创新中心开发,旨在为接受放射治疗的患者优化价值。通过将报销从按服务收费转向前瞻性捆绑支付系统,RO-APM 旨在在放射肿瘤学领域弯曲成本曲线,同时保持甚至提高治疗效果。与之前的大规模政策举措一样,RO-APM 对护理提供的影响的性质和规模将因各种当地因素而有很大差异,包括实践环境。城市学术中心通过引领创新、管理最复杂的病例、培训下一代放射肿瘤学家,以及经常照顾弱势患者群体,在放射肿瘤学中发挥着关键作用。因此,为了保护患者获得这种高质量的癌症护理,在实施之前,必须对 RO-APM 对大型城市学术机构的预计影响进行特征描述,包括可能出现的意外不利后果。在这里,我们概述了放射肿瘤学报销的这一重大变化,并讨论了其对大型城市学术机构的独特潜在影响,以促进必要的准备,并为模型的未来修订提供信息。