How Will the Radiation Oncology Alternative Payment Model Affect Community Practices?

An article published in JCO Oncology Practice explored the effects the Radiation Oncology Alternative Payment Model (APM) will have on hospital-based and free-standing community cancer centers (2021;OP2100298. doi:10.1200/OP.21.00298).

The Radiation Oncology APM is scheduled to go into effect in January 2022. Sanford Meeks, PhD, Department of Radiation Oncology, Orlando Health Cancer Institute, FL, and colleagues explored the effect this APM will have on community cancer centers.

Researchers reviewed historical Medicare data used to generate the Radiation Oncology APM base rates and performed a sensitivity analysis comparing it with current reimbursements for commonly accepted treatment schedules.

The base rates in the Radiation Oncology APM represent a 2.2% decrease in overall Medicare reimbursement. For free-standing community cancer centers, the Radiation Oncology APM base rates represent a 6% decrease in global reimbursement.

Results from the sensitivity analysis showed that moderately hypofractionated treatment schedules will received comparable reimbursement under the Radiation Oncology APM, except for proton therapy. Treatments that require a higher number of fractions of intensity-modulated radiation therapy or protons will see larger decreases in reimbursement.

Medicare reimbursement reductions could be as large as 23%, according to sensitivity analysis.

“Compared with historical Medicare reimbursement, RO-APM base rates provide lower reimbursement for many common treatment scenarios, and this will have a larger effect on centers that use complex treatment techniques and longer fractionation schedules or have a large Medicare population,” concluded Dr Meeks and colleagues.—Janelle Bradley