Radiation Oncology Alternative Payment Model (RO-APM) Monte Carlo Simulations to Predict Financial Impact and Viability for Common Practice Types.

Purpose/Objective(s) The RO-APM will trial an episode-based payment schema over a five-year period starting in 2022. Practices were randomly selected for mandatory inclusion in the RO-APM. Participating departments have different case mixes, patients, and clinical practices that will dictate the relative impact of the RO-APM. It is our aim to create a highly versatile Monte Carlo model to simulate RO-APM effects on reimbursement and practice financial stability. In this study, we specifically focus on suburban and rural settings. Materials/Methods Monte Carlo simulations were developed in Python to model the effects of the RO-APM model over the 5-year trial period. The model requires a patient population, distribution of delivery techniques, and fractionation patterns per delivery technique for each of the 16 defined disease sites. This information was gathered from two non-associated regional clinics: one that serves primarily a suburban population (SP) while the other serves a mixed SP and rural population (MP). All fixed and variable financial expenses were collected and included. The inclusion of extra administrative work for the RO-APM submission was also included using time-driven activity-based costing methods. Considering each clinic's Medicare population, statistical analyses of how the patient population, delivery technique, and fractionation patterns impact reimbursement for this subset population was performed. The RO-APM model was also compared to the fee-for-service model (FFS-M). Results Disease site distributions were within 7.5% absolute difference between the two clinics. The four most common disease sites treated averaged between the two clinics were lung (20.1%), breast (16.9%), prostate (12.6%), and head & neck (H&N) (9.9%). Fractionation patterns were within 3 fractions (fx) across all disease site modalities except for bladder (MP +19fx) and lung (MP +13fx) IMRT, and 3D H&N (MP +3.4fx). Medicare population was 30% and 33% for the SP and MP, respectively. The SP had a 10.4% ± 0.5% higher reimbursement rate in the RO-APM when compared to the FFS-M for its set of patients seen. The MP had a 5.0% ± 0.3% higher reimbursement rate in the RO-APM when compared to the FFS-M for its patient population. Investigating fractionation impact further, the correlation between the number of fractions across all sites/modalities and reimbursement rate increase for the RO-APM compared to the FFS-M was r (498) = -.45, P Conclusion In our analysis using extracted clinical patterns from two separate clinics, lower fractionation patterns can lead to a higher return on investment in the RO-APM compared to the FFS-M, demonstrating viability of the proposed RO-APM.