Improving the Radiation Oncology Alternative Payment Model

Abstract

The Centers for Medicare and Medicaid Services (CMS) proposed Radiation Oncology Alternative Payment Model (RO-APM) intends to introduce an episode-based compensation model and is currently delayed until further notice. We aimed to investigate cost implications of factors not considered in the initial model. We analyzed data from 10,226 patients who were treated with radiotherapy from 2018-2021 at Mayo Clinic in Minnesota, Florida, and Arizona. Mean total radiotherapy costs were calculated using inflation adjusted standardized Medicare rates for all codes in the RO-APM. Curative intent radiotherapy was delivered for 64.4% of patients while the remaining 35.6% was palliative intent. Patients receiving protons composed of 22.2% of all radiotherapy patients. Median number of fractions was 10. Mean cost for all curative treatments was $31,035 vs. $10,428 for all palliative patients (p<0.01). Mean cost for all patients treated with protons was $45,966 vs. $17,541 with photons (p<0.01). Mean costs for patients treated with 1-5 fractions, 6-10 fractions, 11-20 fractions, and >20 fractions were $11,261, $13,712, $21,793, and $45,672 respectively (p<0.01). Factors not considered in the final CMS RO-APM proposal such as treatment intent, utilization of proton therapy, and fractionation scheme all have significant cost implications and should be accounted for in future national base rate calculations.