PURPOSE: Proton beam therapy (PBT) centers have drawn increasing public scrutiny for their high cost. The behavior of such facilities is likely to change under the Affordable Care Act. We modeled how accountable care reform may affect the financial standing of PBT centers and their incentives to treat complex patient cases. METHODS AND MATERIALS: We used operational data and publicly listed Medicare rates to model the relationship between financial metrics for PBT center performance and case mix (defined as the percentage of complex cases, such as pediatric central nervous system tumors). Financial metrics included total daily revenues and debt coverage (daily revenues - daily debt payments). Fee-for-service (FFS) and accountable care (ACO) reimbursement scenarios were modeled. Sensitivity analyses were performed around the room time required to treat noncomplex cases: simple (30 minutes), prostate (24 minutes), and short prostate (15 minutes). Sensitivity analyses were also performed for total machine operating time (14, 16, and 18 h/d). RESULTS: Reimbursement under ACOs could reduce daily revenues in PBT centers by up to 32%. The incremental revenue gained by replacing 1 complex case with noncomplex cases was lowest for simple cases and highest for short prostate cases. ACO rates reduced this incremental incentive by 53.2% for simple cases and 41.7% for short prostate cases. To cover daily debt payments after ACO rates were imposed, 26% fewer complex patients were allowable at varying capital costs and interest rates. Only facilities with total machine operating times of 18 hours per day would cover debt payments in all scenarios. CONCLUSIONS: Debt-financed PBT centers will face steep challenges to remain financially viable after ACO implementation. Paradoxically, reduced reimbursement for noncomplex cases will require PBT centers to treat more such cases over cases for which PBT has demonstrated superior outcomes. Relative losses will be highest for those facilities focused primarily on treating noncomplex cases.
PURPOSE: Proton beam therapy (PBT) centers have drawn increasing public scrutiny for their high cost. The behavior of such facilities is likely to change under the Affordable Care Act. We modeled how accountable care reform may affect the financial standing of PBT centers and their incentives to treat complex patient cases. METHODS AND MATERIALS: We used operational data and publicly listed Medicare rates to model the relationship between financial metrics for PBT center performance and case mix (defined as the percentage of complex cases, such as pediatric central nervous system tumors). Financial metrics included total daily revenues and debt coverage (daily revenues - daily debt payments). Fee-for-service (FFS) and accountable care (ACO) reimbursement scenarios were modeled. Sensitivity analyses were performed around the room time required to treat noncomplex cases: simple (30 minutes), prostate (24 minutes), and short prostate (15 minutes). Sensitivity analyses were also performed for total machine operating time (14, 16, and 18 h/d). RESULTS: Reimbursement under ACOs could reduce daily revenues in PBT centers by up to 32%. The incremental revenue gained by replacing 1 complex case with noncomplex cases was lowest for simple cases and highest for short prostate cases. ACO rates reduced this incremental incentive by 53.2% for simple cases and 41.7% for short prostate cases. To cover daily debt payments after ACO rates were imposed, 26% fewer complex patients were allowable at varying capital costs and interest rates. Only facilities with total machine operating times of 18 hours per day would cover debt payments in all scenarios. CONCLUSIONS: Debt-financed PBT centers will face steep challenges to remain financially viable after ACO implementation. Paradoxically, reduced reimbursement for noncomplex cases will require PBT centers to treat more such cases over cases for which PBT has demonstrated superior outcomes. Relative losses will be highest for those facilities focused primarily on treating noncomplex cases.
Authors: Shervin M Shirvani; Jing Jiang; Daniel R Gomez; Joe Y Chang; Thomas A Buchholz; Benjamin D Smith Journal: Lung Cancer Date: 2013-08-21 Impact factor: 5.705
Authors: Christopher R Peeler; Dragan Mirkovic; Uwe Titt; Pierre Blanchard; Jillian R Gunther; Anita Mahajan; Radhe Mohan; David R Grosshans Journal: Radiother Oncol Date: 2016-11-16 Impact factor: 6.280
Authors: Omar A Zeidan; Ethan Pepmiller; Twyla Willoughby; Zhiqiu Li; James Burkavage; Brian Harper; Michael Fraser; Katie Moffatt; Sanford L Meeks; Naren Ramakrishna Journal: Int J Part Ther Date: 2022-07-01
Authors: Matthew K Forsthoefel; Elizabeth Ballew; Keith R Unger; Peter H Ahn; Sonali Rudra; Dalong Pang; Sean P Collins; Anatoly Dritschilo; William Harter; Nitika Paudel; Brian T Collins; Jonathan W Lischalk Journal: Front Oncol Date: 2020-05-29 Impact factor: 6.244
Authors: Alexander Lin; John H C Chang; Ryan S Grover; Frank J P Hoebers; Upendra Parvathaneni; Samir H Patel; Juliette Thariat; David J Thomson; Johannes A Langendijk; Steven J Frank Journal: Int J Part Ther Date: 2021-06-25