Assessment of MRI-Linac Economics under the RO-APM

Abstract

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.

Emergence of MR-Linac in Radiation Oncology: Successes and Challenges of Riding on the MRgRT Bandwagon

“…To recoup the cost, either the number of treated patients must increase or reimbursement should become more favorable. Some of the economics of MRL and adaptive therapy have been addressed by Palm et al [ 69 ].…”

Patient specific contouring region of interest for abdominal stereotactic adaptive radiotherapy

“…Abdominal stereotactic adaptive radiotherapy (ART) is associated with improved dosimetric and clinical outcomes [1] , [2] . However, ART can be both a time and resource consuming process, including the need to recontour the daily anatomy [3] , [4] , [5] . To limit contouring time during ART while also ensuring that all relevant organs-at-risk (OARs) dose objectives are evaluated, a confined-expansion contouring region-of-interest (CRoI) is typically defined around the target.…”