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Mantz CA, Yashar CM, Bajaj GK, Sandler HM. Recent Trends in Medicare Payments for Outpatient Cancer Care at the End of Life. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00028-7. [PMID: 36657498 DOI: 10.1016/j.ijrobp.2023.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE Outpatient care for cancer patients compromises 60 - 70% of healthcare costs over the last 6 months of life. Recent approvals for expensive biologics and growing support for lower-cost hypofractionated radiotherapy in the palliative management of advanced cancer have introduced offsetting spending effects on end-of-life care that may shift overall expenditures for this patient cohort. METHODS AND MATERIALS In this descriptive retrospective cohort study, end-of-life care is defined as the aggregate of medical services and supplies, including drugs, furnished to cancer patients in the outpatient setting over the last 6 months of life. 84,744 Medicare beneficiaries with a cancer diagnosis were identified as having died between Jan 1 2016 and Dec 31 2019. Beneficiaries with Medicare Advantage are not included in this study. Medicare Standard Analytic Files were abstracted for all paid claims for these beneficiaries over the last 6 months of life, and provider payments were summed according to service/supply category and year of death. Comparisons of service and supply utilization and costs between patient groups were performed using Pearson's chi square test. RESULTS Average total Medicare Part B payments per treated beneficiary over the last 6 month of life increased by 12.0% between 2016 - 2019 (from $14,487 to $16,227) with the greatest absolute cost increase observed for the Medical Oncology category (from $7,030 to $9,436 [+34.2%]). Within the Medical Oncology category, drug utilization shifted away from less costly chemotherapy and hormone therapy agents and toward more expensive immunotherapy agents. The increase in immunotherapy utilization and drug costs alone accounted for 84% of the increase in total Part B payments for all categories during the period. CONCLUSION While costs related to end-of-life care for nearly all cost categories have remained relatively stable, oncology drug costs overall and immunotherapy costs specifically have accelerated and account almost entirely for the observed overall increase in outpatient cost burden for Medicare.
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Affiliation(s)
| | - Catheryn M Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Gopal K Bajaj
- Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, VA
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Jacobson GM, Bajaj GK, Buatti JM, Dawson L, Deville C, Eichler TJ, Erickson B, Ford E, Gibbs IC, Mantz C, Marples B, Michalski JM, Sandler H, Smith B, Vapiwala N, Yashar C. ASTRO Supports Access to Evidence-Based Cancer Care for All Patients, Regardless of Pregnancy Status, and Protection for Physicians Recommending and Providing Evidence-Based Care. Int J Radiat Oncol Biol Phys 2022; 114:390-392. [PMID: 35963472 DOI: 10.1016/j.ijrobp.2022.07.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 07/31/2022] [Indexed: 10/31/2022]
Affiliation(s)
| | - Gopal K Bajaj
- Department of Radiation Oncology, Inova Schar Cancer Institute, Fairfax, Virginia
| | - John M Buatti
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Laura Dawson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | | | | | - Eric Ford
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | | | | | - Brian Marples
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Jeff M Michalski
- Siteman Cancer Center, Washington University, St. Louis, Missouri
| | | | - Benjamin Smith
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catheryn Yashar
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California
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Chaurasia AR, Page BR, Walker AJ, Salerno K, Camphausen K, Kwok Y, Bajaj GK, Ambrocio D, Erickson D. Lessons to Learn From a Successful Virtual Mock Oral Examination Pilot Experience. Adv Radiat Oncol 2020; 6:100534. [PMID: 32838071 PMCID: PMC7414305 DOI: 10.1016/j.adro.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 11/15/2022] Open
Abstract
oronavirus (COVID-19) has caused marked impact on graduate medical education for all medical specialties. Radiation Oncology and the American Board of Radiology have also had to rapidly adapt to converting education and examinations to virtual platforms. We describe our small pilot experience in transitioning our in-person mock oral examinations to a virtual platform. Survey-based assessment revealed excellent feedback regarding ease of use and educational usefulness. Our mock oral examinations pilot experience adds to evidence that virtual mock oral examinations are an important considerationfor Radiation Oncology education and a feasible alternative to an in-person oral examination.
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Affiliation(s)
- Avinash R. Chaurasia
- National Capital Consortium Radiation Oncology Residency, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Radiation Oncology Service, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Brandi R. Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Amanda J. Walker
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Kilian Salerno
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kevin Camphausen
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Young Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gopal K. Bajaj
- Center for Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Daisy Ambrocio
- National Capital Consortium Radiation Oncology Residency, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Delnora Erickson
- National Capital Consortium Radiation Oncology Residency, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Radiation Oncology Service, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland
- Corresponding author: Delnora Erickson, MD
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Waddle MR, Stross WC, Vallow LA, Naessens JM, White L, Meier S, Spaulding AC, Buskirk SJ, Trifiletti DM, Keole SR, Ma DJ, Bajaj GK, Laack NN, Miller RC. Impact of Patient Stage and Disease Characteristics on the proposed Radiation Oncology Alternative Payment Model (RO-APM). Int J Radiat Oncol Biol Phys 2020; 106:905-911. [PMID: 32001382 DOI: 10.1016/j.ijrobp.2019.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/02/2019] [Accepted: 12/14/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE The proposed Radiation Oncology Alternative Payment Model (RO-APM) released on July 10, 2019, represents a dramatic shift from fee-for-service (FFS) reimbursement in radiation therapy (RT). This study compares historical revenue at Mayo Clinic to the RO-APM and quantifies the effect that disease characteristics may have on reimbursement. METHODS AND MATERIALS FFS Medicare reimbursements were determined for patients undergoing RT at Mayo Clinic from 2015 to 2016. Disease categories and payment episodes were defined as per the RO-APM. Average RT episode reimbursements were reported for each disease site, except for lymphoma and metastases, and stratified by stage and disease subcategory. Comparisons with RO-APM reimbursements were made via descriptive statistics. RESULTS A total of 2098 patients were identified, of whom 1866 (89%) were categorized per the RO-APM; 840 (45%) of those were aged >65 years. Breast (33%), head and neck (HN) (14%), and prostate (11%) cancer were most common. RO-APM base rate reimbursements and sensitivity analysis range were lower than historical reimbursement for bladder (-40%), cervical (-34%), lung (-28%), uterine (-26%), colorectal (-24%), upper gastrointestinal (-24%), HN (-23%), pancreatic (-20%), prostate (-16%), central nervous system (-13%), and anal (-10%) and higher for liver (+24%) and breast (+36%). Historical reimbursement varied with stage (stage III vs stage I) for breast (+57%, P < .01), uterine (+53%, P = .01), lung (+50%, P < .01), HN (+24%, P = .01), and prostate (+13%, P = .01). Overall, for patients older than 65 years of age, the RO-APM resulted in a -9% reduction in total RT reimbursement compared with historical FFS (-2%, -15%, and -27% for high, mid, and low adjusted RO-APM rates). CONCLUSIONS Our findings indicate that the RO-APM will result in significant reductions in reimbursement at our center, particularly for cancers more common in underserved populations. Practices that care for socioeconomically disadvantaged populations may face significant reductions in revenue, which could further reduce access for this vulnerable population.
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Affiliation(s)
- Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - William C Stross
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Laura A Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - James M Naessens
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Launia White
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Sarah Meier
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Aaron C Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Steven J Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Gopal K Bajaj
- Center for Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Robert C Miller
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
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Sher DJ, Adelstein DJ, Bajaj GK, Brizel DM, Cohen EE, Halthore A, Harrison LB, Lu C, Moeller BJ, Quon H, Rocco JW, Sturgis EM, Tishler RB, Trotti A, Waldron J, Eisbruch A. Response to ASTRO consensus guideline for oropharyngeal cancer: In Regard to Walker et al. Pract Radiat Oncol 2018; 8:e185-e186. [PMID: 29724403 DOI: 10.1016/j.prro.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
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Sher DJ, Adelstein DJ, Bajaj GK, Brizel DM, Cohen EE, Halthore A, Harrison LB, Lu C, Moeller BJ, Quon H, Rocco JW, Sturgis EM, Tishler RB, Trotti A, Waldron J, Eisbruch A. Radiation therapy for oropharyngeal squamous cell carcinoma: Executive summary of an ASTRO Evidence-Based Clinical Practice Guideline. Pract Radiat Oncol 2017; 7:246-253. [DOI: 10.1016/j.prro.2017.02.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
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Bajaj GK, Kleinberg L, Terezakis S. Current Concepts and Controversies in the Treatment of Parenchymal Brain Metastases: Improved Outcomes with Aggressive Management. Cancer Invest 2009; 23:363-76. [PMID: 16100948 DOI: 10.1081/cnv-58889] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The multimodality management of brain metastases has undergone significant refinement in the last decade. Although brain metastases remain a significant source of morbidity and mortality for many cancer patients, aggresive management has led to pronounced gains in neurological functioning, disease free survival and overall survival compared to standard treatment regimens consisting of only whole brain radiation therapy. Representative studies reviewing the role of aggressive management approaches including surgical resection with or without whole brain radiation therapy or non-surgical approaches employing stereotactic radiosurgery alone or in combination with whole brain radiation therapy are highlighted. Additionally, the emerging role of systemic agents showing distinct clinical activity in patients with brain metastases are also discussed. As we continue to gain advances in systemic therapies for metastatic disease, local control of brain metastases in these patients is likely to become more critical in improving survival and quality of life, thereby calling for a more aggressive multi-modal approach to this population of patients.
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Affiliation(s)
- Gopal K Bajaj
- Department of Radiation Oncology and Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA
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Lin SH, Latronico D, Teslow T, Bajaj GK. A Highly Reproducible Bolus Immobilization Technique for the Treatment of Scalp Malignancies. Med Dosim 2008; 33:30-5. [DOI: 10.1016/j.meddos.2007.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 04/17/2007] [Accepted: 04/17/2007] [Indexed: 11/24/2022]
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Bajaj GK, Zhang Z, Garrett-Mayer E, Drew R, Sinibaldi V, Pili R, Denmeade SR, Carducci MA, Eisenberger MA, DeWeese TL. Phase II study of imatinib mesylate in patients with prostate cancer with evidence of biochemical relapse after definitive radical retropubic prostatectomy or radiotherapy. Urology 2007; 69:526-31. [PMID: 17382158 DOI: 10.1016/j.urology.2006.12.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 09/18/2006] [Accepted: 12/11/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Patients with biochemical recurrence of prostate cancer after definitive or salvage local therapy in the absence of metastatic disease represent a group well suited to a novel therapeutic intervention. Imatinib mesylate (Gleevec) is a protein-tyrosine kinase inhibitor that has previously been tested in men with androgen-independent and metastatic prostate cancer. This Phase II study was undertaken to determine the safety and efficacy of imatinib mesylate in men with biochemical relapse of nonmetastatic, androgen-sensitive prostate cancer after local therapy. METHODS Twenty-seven patients were treated with imatinib mesylate 400 mg twice daily for up to 12 months. Three patients (11%) completed less than 4 weeks of therapy and were included in the intent-to-treat analysis of the response to therapy. RESULTS Of the 27 patients treated, 5 (18.5%) had a stable prostate-specific antigen (PSA) during the course of treatment; 2 patients (7.4%) experienced a partial response. The remaining 20 patients (74.1%) demonstrated PSA progression. The median progression-free survival was 3 months. The proportion of patients achieving a partial PSA response during therapy did not significantly differ from the null rate of 5% (P = 0.394). Seven patients (25.9%) discontinued therapy secondary to grade 1 to 3 toxicities. No irreversible National Institutes of Health Common Toxicity Criteria grade 3 or 4 toxicities occurred. Grade 3 and 4 toxicity included leukopenia (3.7%), serum glutamic-oxaloacetic transaminase (3.7%) and serum glutamic-pyruvic transaminase (3.7%) elevation, and rash (18.5%). CONCLUSIONS The results of our study have demonstrated that imatinib mesylate delivered at a dose of 400 mg twice daily is associated with a moderate degree of toxicity and a limited PSA response in this patient population.
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Affiliation(s)
- Gopal K Bajaj
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA
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Frassica DA, Bajaj GK, Tsangaris TN. Treatment of complications after breast-conservation therapy. Oncology (Williston Park) 2003; 17:1118-28; discussion 1131-6, 1141. [PMID: 12966679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Over the past 2 decades, breast-conservation therapy with lumpectomy and whole-breast radiotherapy has become a standard option for the majority of women with newly diagnosed breast cancer. Long-term local control is achieved in approximately 85% of patients, and the therapy is generally well tolerated. There can, however, be long-term effects on the breast and other nearby tissues that may range from asymptomatic findings on examination to severe, debilitating problems. Infection, fat necrosis, and severe musculoskeletal problems such as osteoradionecrosis or soft-tissue necrosis are uncommon, affecting less than 5% of patients. However, changes in range of motion, mild-to-moderate musculoskeletal pain, and arm and breast edema are much more common. As more women choose breast-conservation therapy for management of their breast cancer, physicians will encounter these problems, as well as in-breast tumor recurrence, with greater frequency. This review will focus on the incidence, contributing factors, and management of the late problems of infection, fat necrosis, musculoskeletal complications, and local recurrence following breast-conservation therapy.
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Affiliation(s)
- Deborah A Frassica
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Department of Radiation Oncology, Baltimore, Maryland, USA.
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