1
|
Faraj KS, Kaufman SR, Herrel LA, Maganty A, Oerline MK, Caram MEV, Shahinian VB, Hollenbeck BK. Urologist practice divestment from radiation vault ownership and treatment patterns for prostate cancer. Cancer 2024; 130:1609-1617. [PMID: 38146764 PMCID: PMC11009074 DOI: 10.1002/cncr.35168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/23/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Urologists practicing in single-specialty groups with ownership in radiation vaults are more likely to treat men with prostate cancer. The effect of divestment of vault ownership on treatment patterns is unclear. METHODS A 20% sample of national Medicare claims was used to perform a retrospective cohort study of men with prostate cancer diagnosed between 2010 and 2019. Urology practices were categorized by radiation vault ownership as nonowners, continuous owners, and divested owners. The primary outcome was use of local treatment, and the secondary outcome was use of intensity-modulated radiation therapy (IMRT). A difference-in-differences framework was used to measure the effect of divestment on outcomes compared to continuous owners. Subgroup analyses assessed outcomes by noncancer mortality risk (high [>50%] vs. low [≤50%]). RESULTS Among 72 urology practices that owned radiation vaults, six divested during the study. Divestment led to a decrease in treatment compared with those managed at continuously owning practices (difference-in-differences estimate, -13%; p = .03). The use of IMRT decreased, but this was not statistically significant (difference-in-differences estimate, -10%; p = .13). In men with a high noncancer mortality risk, treatment (difference-in-differences estimate, -28%; p < .001) and use of IMRT (difference-in-differences estimate, -27%; p < .001) decreased after divestment. CONCLUSIONS Urology group divestment from radiation vault ownership led to a decrease in prostate cancer treatment. This decrease was most pronounced in men who had a high noncancer mortality risk. This has important implications for health care reform by suggesting that payment programs that encourage constraints on utilization, when appropriate, may be effective in reducing overtreatment.
Collapse
Affiliation(s)
- Kassem S Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mary K Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Megan E. V. Caram
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | |
Collapse
|
2
|
Hogan JS, Karraker P, Fischer-Valuck BW, Vapiwala N, Mehta MP, Perez CA, Baumann JC, Bradley JD, Baumann BC. Benchmarking the Radiation Oncology Alternative Payment Model: Changes in Medicare Reimbursement for 16 Common Radiation Therapy Treatment Courses. Pract Radiat Oncol 2023; 13:e389-e394. [PMID: 37172757 DOI: 10.1016/j.prro.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
Radiation oncology (RO) has seen declines in Medicare reimbursement (MCR) in the past decade under the current fee-for-service model. Although studies have explored decline in reimbursement at a per-code level, to our knowledge there are no recent studies analyzing changes in MCR over time for common RO treatment courses. By analyzing changes in MCR for common treatment courses, our study had 3 objectives: (1) to provide practitioners and policymakers with estimates of recent reimbursement changes for common treatment courses; (2) to provide an estimate of how reimbursement will change in the future under the current fee-for-service model if current trends continue; and (3) to provide a baseline for treatment episodes in the event that the episode-based Radiation Oncology Alternative Payment Model is eventually implemented. Specifically, we quantified inflation- and utilization-adjusted changes in reimbursement for 16 common radiation therapy (RT) treatment courses from 2010 to 2020. Centers for Medicare & Medicaid Services Physician/Supplier Procedure Summary databases were used to obtain reimbursement for all RO procedures in 2010, 2015, and 2020 for free-standing facilities. Inflation-adjusted average reimbursement (AR) per billing instance was calculated for each Healthcare Common Procedure Coding System code using 2020 dollars. For each year, the billing frequency of each code was multiplied by the AR per code. Results were summed per RT course per year, and AR for RT courses were compared. Sixteen common RO courses for head and neck, breast, prostate, lung, and palliative RT were analyzed. AR decreased for all 16 courses from 2010 to 2020. From 2015 to 2020, the only course that increased in AR was palliative 2-dimensional 10-fraction 30 Gy, which increased by 0.4%. Courses using intensity modulated RT saw the largest AR decline from 2010 to 2020, ranging from 38% to 39%. We report significant declines in reimbursement from 2010 to 2020 for common RO courses, with the largest declines for intensity modulated RT. Policymakers should consider the significant cuts to reimbursement that have already occurred when considering future reimbursement adjustment under the current fee-for-service model or when considering mandatory adoption of a new payment system with further cuts and the negative effect of such cuts on quality and access to care.
Collapse
Affiliation(s)
- Jacob S Hogan
- Washington University School of Medicine, St. Louis, Missouri
| | - Patricia Karraker
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Carlos A Perez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Jeffrey D Bradley
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri; Department of Radiation Oncology, Springfield Clinic, Springfield, Illinois.
| |
Collapse
|
3
|
Modi PK, Ward KC, Filson CP. Characteristics of prostate cancer patients captured by facility-based versus geography-based cancer registries. Urol Oncol 2023; 41:324.e1-324.e7. [PMID: 37150737 DOI: 10.1016/j.urolonc.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/15/2023] [Accepted: 04/09/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE We determined differences in demographics, tumor factors, and treatment patterns of prostate cancer patients in a geographic-based cancer registry based on eligibility for a facility-based cancer registry system. METHODS We identified prostate cancer patients captured by the Surveillance, Epidemiology, and End Results (SEER) database from 2018 to 2019. Our exposure was receipt of cancer care at a facility accredited by the American College of Surgeons' Commission on Cancer (CoC) providing eligibility for inclusion in the National Cancer Database (NCDB). Outcomes included patient demographics, tumor factors (e.g., biopsy grade), and treatment with radical prostatectomy. RESULTS We identified 113,733 prostate cancer patients of whom 65,708 (57%) were NCDB-eligible with an analytic abstract, and 11,010 (10%) were NCDB-eligible without an analytic abstract. NCDB-eligible men were younger (67.0 vs. 68.1 years, P < 0.001), less likely to be Hispanic/Latino (8.7% vs. 13.2%, P < 0.001), and more likely in a county with median income over $75,000 (40.9% vs. 30.0%, P < 0.001). NCDB eligibility varied widely by registry, from 95.9% in Connecticut to 42.6% in Utah. NCDB-ineligible patients were more likely to have unknown stage (17.2% vs. 2.9% NCDB-eligible) and missing PSA (22.9% vs 9.3% NCDB-eligible). NCDB-eligible men were less likely to have Grade Group 1 cancer on biopsy (28.2% vs. 39.2%, P < 0.001). Treatment with prostatectomy was more common among NCDB-eligible patients for low-risk (19.6% vs. 8.8%, adjusted OR 2.30, 95% CI 1.72-6.66) and high-risk tumors (43.5% vs. 26.0%, adjusted OR 1.95, 95% CI 1.33-2.86). CONCLUSION Compared NCDB-ineligible patients, those eligible for inclusion in the NCDB have important differences in demographics, eligibility for active surveillance, and treatment patterns. Generalizations related to epidemiologic trends, practice patterns, and outcomes for this select population should be interpreted with caution.
Collapse
Affiliation(s)
- Parth K Modi
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Christopher P Filson
- Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Department of Urology, Emory University School of Medicine, Atlanta, GA.
| |
Collapse
|
4
|
Shih YCT, Xu Y, Bradley C, Giordano SH, Yao J, Yabroff KR. Costs Around the First Year of Diagnosis for 4 Common Cancers Among the Privately Insured. J Natl Cancer Inst 2022; 114:1392-1399. [PMID: 36099068 PMCID: PMC9552304 DOI: 10.1093/jnci/djac141] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/03/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We estimated trends in total and out-of-pocket (OOP) costs around the first year of diagnosis for privately insured nonelderly adult cancer patients. METHODS We constructed incident cohorts of breast, colorectal, lung, and prostate cancer patients diagnosed between 2009 and 2016 using claims data from the Health Care Cost Institute. We identified cancer-related surgery, intravenous (IV) systemic therapy, and radiation and calculated associated total and OOP costs (in 2020 US dollars). We assessed trends in health-care utilization and cost by cancer site with logistic regressions and generalized linear models, respectively. RESULTS The cohorts included 105 255 breast, 23 571 colorectal, 11 321 lung, and 59 197 prostate cancer patients. For patients diagnosed between 2009 and 2016, total mean costs per patient increased from $109 544 to $140 732 for breast (29%), $151 751 to $168 730 for lung (11%) or $53 300 to $55 497 for prostate (4%) cancer were statistically significant. Increase for colorectal cancer (1%, $136 652 to $137 663) was not statistically significant (P = .09). OOP costs increased to more than 15% for all cancers, including colorectal, to more than $6000 by 2016. Use of IV systemic therapy and radiation statistically significantly increased, except for lung cancer. Cancer surgeries statistically significantly increased for breast and colorectal cancer but decreased for prostate cancer (P < .001). Total costs increased statistically significantly for nearly all treatment modalities, except for IV systemic therapy in colorectal and radiation in prostate cancer. CONCLUSIONS Rising costs of cancer treatments, compounded with greater cost sharing, increased OOP costs for privately insured, nonelderly cancer patients. Policy initiatives to mitigate financial hardship should consider cost containment as well as insurance reform.
Collapse
Affiliation(s)
- Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Xu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cathy Bradley
- Department of Health Systems, Management & Policy, University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, CO, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James Yao
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| |
Collapse
|
5
|
Boyce-Fappiano D, Ning MS, Gjyshi O, Mesko S, Pasalic D, Chang AJ, Orio PF, Thaker NG. Payment Methodology for the Radiation Oncology Alternative Payment Model: Implications for Practices and Suggestions for Improvement. JCO Oncol Pract 2021; 17:761-764. [PMID: 34097458 DOI: 10.1200/op.21.00200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Matthew S Ning
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Olsi Gjyshi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shane Mesko
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dario Pasalic
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Albert J Chang
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Peter F Orio
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | | |
Collapse
|
6
|
Smith GL, Smith BD. Sea Change: A Decade of Intensity-Modulated Radiation Therapy for Treatment of Breast Cancer. J Natl Cancer Inst 2020; 112:221-223. [PMID: 31647554 DOI: 10.1093/jnci/djz199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Grace L Smith
- Department of Radiation Oncology and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Benjamin D Smith
- Department of Radiation Oncology and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
7
|
Shelton JB, Paivanas TA, Buffington P, Ruyle SR, Cohen ES, Natale R, Mehlhaff B, Suh R, Bradford TJ, Koo AS, Kwan L, Shore N. Three-year Active Surveillance Outcomes in a Contemporary Community Urology Cohort in the United States. Urology 2019; 130:72-78. [DOI: 10.1016/j.urology.2019.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/08/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
|
8
|
Contemporary Management of Incident Prostate Cancer in Large Community Urology Practices in the United States. Urology 2019; 129:79-86. [DOI: 10.1016/j.urology.2019.01.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/08/2019] [Accepted: 01/31/2019] [Indexed: 01/17/2023]
|
9
|
Elson JK, Kachnic LA, Kharofa JR. Intensity-modulated radiotherapy improves survival and reduces treatment time in squamous cell carcinoma of the anus: A National Cancer Data Base study. Cancer 2018; 124:4383-4392. [DOI: 10.1002/cncr.31721] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 03/22/2018] [Accepted: 06/15/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Joshua K. Elson
- Department of Radiation Oncology; University of Cincinnati; Cincinnati Ohio
- Barrett Cancer Center; University of Cincinnati; Cincinnati Ohio
| | - Lisa A. Kachnic
- Department of Radiation Oncology; Vanderbilt University; Nashville Tennessee
| | - Jordan R. Kharofa
- Department of Radiation Oncology; University of Cincinnati; Cincinnati Ohio
- Barrett Cancer Center; University of Cincinnati; Cincinnati Ohio
| |
Collapse
|