放射肿瘤病例率 (ROCR) 旨在将放射报销从按服务收费 (FFS) 转变为捆绑支付，这将使美国的分次与报销脱钩。本研究将三个大型中心和国家医疗保险样本的历史报销率与 ROCR 提议的基本费率进行了比较。它还测试了治疗方法和疾病特征的影响，以确定是否有任何变量与可能导致不公平报销的较大费率差异相关。使用 2017-2020 年的 XXXX 电子病历数据和 Medicare 5% 的 B 部分索赔根据研究可识别文件 (RIF)，根据 ROCR 支付方法计算 15 种癌症类型的间歇性 90 天历史报销率。 XXXX 报销率按疾病和治疗特征进行分层，并进行多元线性回归以评估这些变量与历史发作报销率的关联。从 XXXX 起，纳入了 3,498 例患者发作，其中 480,526 例来自 RIF。从这两个数据集中，25% 的脑转移和 13% 的骨转移发作包括 ≥2 个疗程，疗程之间平均间隔 51 天。考虑到所有 15 种癌症类型，与历史报销相比，ROCR 基本费率导致 XXXX 和 RIF 的费率分别平均降低 -2.4% 和 -2.9%。根据 XXXX 数据的多变量分析，对于 12 种适用癌症类型中的 12 种，治疗意图（治愈与姑息治疗）与较高的历史报销（477 美元至 7,417 美元；p ≤ 0.05）相关。对于 12 种适用癌症类型中的 8 种，分期（3-4 与 1-2）与较高的历史报销（1,169 美元至 3,917 美元；p ≤ 0.05）相关。我们的数据表明 ROCR 基本费率导致报销率平均下降 ≤3%与每种癌症类型的历史 FFS 报销相比，这可以产生国会批准 ROCR 所需的医疗保险节省。估计与未来 FFS 报销的比较需要考虑其他因素，例如大分割利用率的增加、拟议的 FFS 利率削减和通货膨胀更新。对于姑息性发作应考虑不同的速率和缩短的发作持续时间（≤ 30 天）。对每个癌症分期应用基本费率修正可以缓解治疗性晚期患者数量较多的机构（例如农村地区的独立中心）报销的不成比例的减少。版权所有 © 2024。由 Elsevier Inc. 出版。

The Radiation Oncology Case Rate (ROCR) aims to shift radiation reimbursement from fee-for-service (FFS) to bundled payments, which would decouple fractionation from reimbursement in the United States. This study compares historical reimbursement rates from three large centers and a national Medicare sample with proposed base rates from ROCR. It also tests the impact of methodological inclusion of treatment and disease characteristics to determine if any variables are associated with greater rate differences that may lead to inequitable reimbursement.Using XXXX electronic medical record data from 2017-2020 and Part B claims from the Medicare 5% research identifiable files (RIF), episodic 90-day historical reimbursement rates for 15 cancer types were calculated per the ROCR payment methodology. XXXX reimbursement rates were stratified by disease and treatment characteristics and multiple linear regression was performed to assess the association of these variables on historical episode reimbursement rates.From XXXX, 3,498 patient episodes were included and 480,526 from the RIF. From both datasets, 25% of brain metastases and 13% of bone metastases episodes included ≥2 treatment courses with an average of 51 days between courses. Accounting for all 15 cancer types, ROCR base rates resulted in an average -2.4% and -2.9% reduction in rates for XXXX and the RIF respectively compared to historical reimbursement. On multivariate analysis of XXXX data, treatment intent (curative vs. palliative) was associated with higher historical reimbursement (+$477 to +$7,417; p ≤ 0.05) for 12 out of 12 applicable cancer types. Stage (3-4 vs. 1-2) was associated with higher historical reimbursement (+$1,169 to +$3,917; p ≤ 0.05) for 8 out of 12 applicable cancer types.Our data suggest ROCR base rates introduce an average ≤3% reimbursement rate decrease compared to historical FFS reimbursement per cancer type, which could produce the Medicare savings required for congressional approval of ROCR. Estimating comparisons with future FFS reimbursement would require consideration of additional factors such as the increased utilization of hypofractionation, proposed FFS rate cuts, and inflationary updates. A distinct rate and shortened episode duration (≤ 30 days) should be considered for palliative episodes. Applying a base rate modifier per cancer stage may mitigate disproportionate reductions in reimbursement for facilities with a higher volume of curative advanced stage patients such as freestanding centers in rural settings.Copyright © 2024. Published by Elsevier Inc.