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Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results

Assessment of MRI-Linac Economics under the RO-APM

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
Author to whom correspondence should be addressed.
Academic Editors: Indra J. Das and Ernesto Di Cesare
J. Clin. Med. 2021, 10(20), 4706;
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.

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.

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.

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