Palm Russell F, Eicher Kurt G, Sim Austin J, Peneguy Susan, Rosenberg Stephen A, Wasserman Stuart, Johnstone Peter A S
Moffitt Cancer Center, Department of Radiation Oncology, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.
Guidehouse Healthcare Consulting, 150 North Riverside Plaza, Suite 2100, Chicago, IL 60606, USA.
J Clin Med. 2021 Oct 14;10(20):4706. doi: 10.3390/jcm10204706.
The implementation of the radiation oncology alternative payment model (RO-APM) has raised concerns regarding the development of MRI-guided adaptive radiotherapy (MRgART). We sought to compare technical fee reimbursement under Fee-For-Service (FFS) to the proposed RO-APM for a typical MRI-Linac (MRL) patient load and distribution of 200 patients. In an exploratory aim, a modifier was added to the RO-APM (mRO-APM) to account for the resources necessary to provide this care. Traditional Medicare FFS reimbursement rates were compared to the diagnosis-based reimbursement in the RO-APM. Reimbursement for all selected diagnoses were lower in the RO-APM compared to FFS, with the largest differences in the adaptive treatments for lung cancer (-89%) and pancreatic cancer (-83%). The total annual reimbursement discrepancy amounted to -78%. Without implementation of adaptive replanning there was no difference in reimbursement in breast, colorectal and prostate cancer between RO-APM and mRO-APM. Accommodating online adaptive treatments in the mRO-APM would result in a reimbursement difference from the FFS model of -47% for lung cancer and -46% for pancreatic cancer, mitigating the overall annual reimbursement difference to -54%. Even with adjustment, the implementation of MRgART as a new treatment strategy is susceptible under the RO-APM.
放射肿瘤学替代支付模式（RO-APM）的实施引发了人们对磁共振成像引导的自适应放疗（MRgART）发展的担忧。我们试图比较按服务收费（FFS）模式下的技术费用报销情况与针对200例典型磁共振成像直线加速器（MRL）患者负荷及分布所提议的RO-APM模式下的报销情况。在一个探索性目标中，在RO-APM（mRO-APM）中添加了一个修正因子，以考虑提供这种治疗所需的资源。将传统医疗保险FFS报销率与RO-APM中基于诊断的报销率进行了比较。与FFS相比，RO-APM中所有选定诊断的报销率都更低，其中肺癌（-89%）和胰腺癌（-83%）的自适应治疗差异最大。年度报销总差异达-78%。在不实施自适应重新计划的情况下，RO-APM和mRO-APM在乳腺癌、结直肠癌和前列腺癌的报销方面没有差异。在mRO-APM中纳入在线自适应治疗将导致与FFS模式相比，肺癌的报销差异为-47%，胰腺癌为-46%，从而将年度报销总差异减轻至-54%。即使进行了调整，在RO-APM模式下，将MRgART作为一种新的治疗策略实施仍易受到影响。
