Payment Reform Policy and Cancer Disparities in Delivery of Radiotherapy

University Of Utah, Salt Lake City UT

Investigators

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Abstract

PROJECT ABSTRACT This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 23-044. Guideline-concordant radiotherapy is shifting from traditional long-course radiation to newer protocols that are up to 80% shorter. The current fee-for-service (FFS) payment model serves as a barrier for shorter guideline- concordant radiotherapy due to incentivizing longer, complex treatments without regard to quality of care. To address this issue Medicare developed the Radiation Oncology Model (ROM). ROM changes payments to a lump sum for radiation care delivered over a 90-day episode, shifting incentives to encourage efficient care delivery over shorter periods of time. Key stakeholders have raised concerns regarding implementation of ROM given uncertainty in how this payment policy will affect traditionally underserved patients, including racially and ethnically minoritized, rural, and low socioeconomic status groups. This concern continues to serve as a critical barrier to ROM implementation. The purpose of this work is to provide a pre-policy evaluation addressing this key stakeholder concern. There is little evidence to support that ROM implementation may harm traditionally underserved patients. We aim to provide data-driven evidence to better inform ROM implementation. The Specific Aims are to: 1. Determine disparities in receipt of guideline-concordant radiotherapy for traditionally underserved populations. 2. Identify characteristics of practices that deliver more guideline- concordant radiotherapy to traditionally underserved populations. We hypothesize that cancer patients from traditionally underserved groups are less likely to receive guideline-concordant radiotherapy but that practices serving a greater proportion of traditionally underserved patients will have increased delivery of guideline- concordant radiotherapy for those groups. To accomplish these aims, we will utilize Medicare claims data to analyze our cohort of patients aged 65 – 80 diagnosed with specified cancer types. We will utilize data from the National Provider Identifier to analyze practices serving underserved populations. This work supports the goals of the NCI through pre-policy evaluation, with findings that will aid ROM policy implementation to promote guideline-concordant radiotherapy while reducing costs and minimizing risks of reducing access to care for traditionally underserved patient populations.