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Article

Assessment of MRI-Linac Economics under the RO-APM

1
Moffitt Cancer Center, Department of Radiation Oncology, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
2
Guidehouse Healthcare Consulting, 150 North Riverside Plaza, Suite 2100, Chicago, IL 60606, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Indra J. Das and Ernesto Di Cesare
J. Clin. Med. 2021, 10(20), 4706; https://doi.org/10.3390/jcm10204706
Received: 2 September 2021 / Accepted: 8 October 2021 / Published: 14 October 2021
(This article belongs to the Special Issue Advances of MRI in Radiation Oncology)
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. View Full-Text
Keywords: MRI-Linac; RO-APM; adaptive radiotherapy; MRgART; medicare; reimbursement; radiation oncology MRI-Linac; RO-APM; adaptive radiotherapy; MRgART; medicare; reimbursement; radiation oncology
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MDPI and ACS Style

Palm, R.F.; Eicher, K.G.; Sim, A.J.; Peneguy, S.; Rosenberg, S.A.; Wasserman, S.; Johnstone, P.A.S. Assessment of MRI-Linac Economics under the RO-APM. J. Clin. Med. 2021, 10, 4706. https://doi.org/10.3390/jcm10204706

AMA Style

Palm RF, Eicher KG, Sim AJ, Peneguy S, Rosenberg SA, Wasserman S, Johnstone PAS. Assessment of MRI-Linac Economics under the RO-APM. Journal of Clinical Medicine. 2021; 10(20):4706. https://doi.org/10.3390/jcm10204706

Chicago/Turabian Style

Palm, Russell F., Kurt G. Eicher, Austin J. Sim, Susan Peneguy, Stephen A. Rosenberg, Stuart Wasserman, and Peter A.S. Johnstone 2021. "Assessment of MRI-Linac Economics under the RO-APM" Journal of Clinical Medicine 10, no. 20: 4706. https://doi.org/10.3390/jcm10204706

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