T. Lanni

Lymphedema care for the breast cancer patient: an integrative approach.

Lymphedema is a serious complication that involves the accumulation of protein-rich fluid in the interstitial space. Lymphedema is common after treatment for breast cancer, especially for those patients receiving axillary lymph node dissection. Severe lymphedema is associated with serious morbidities such as swelling, fibrosis, decreased function, reduced range of motion, infection, and pain. Here, we discuss a unique, multi-disciplinary approach to effectively manage patients during and after breast cancer therapy. In this approach, patient education and screening are implemented in various departments throughout the health care system, including Physical Therapy and Rehabilitation, Integrative Medicine, and the Breast Care Center, which houses the Lymphedema Clinic. Early patient education and regular screening are combined with aggressive treatment for overt disease to effectively manage lymphedema in the at-risk population.

Variations in Medicare Reimbursement in Radiation Oncology: An Analysis of the Medicare Provider Utilization and Payment Data Set.

PURPOSEnThe purposes of this study were to summarize recently published data on Medicare reimbursement to individual radiation oncologists and to identify the causes of variation in Medicare reimbursement in radiation oncology.nnnMETHODS AND MATERIALSnThe Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF), which details nearly all services provided by radiation oncologists in 2012, was used for this study. The data were filtered and analyzed by physician and by billing code. Statistical analysis was performed to identify differences in reimbursements based on sex, rurality, billing of technical services, or location in a certificate of need (CON) state.nnnRESULTSnThere were 4135 radiation oncologists who received a total of

Trends in Medicare Reimbursement and Work Relative Value Unit Production in Radiation Oncology

1,499,625,803 in payments from Medicare in 2012. Seventy-five percent of radiation oncologists were male. The median reimbursement was

Integrative medicine and the oncology patient: options and benefits

146,453. The code with the highest total reimbursement was 77418 (radiation treatment delivery intensity modulated radiation therapy [IMRT]). The most commonly billed evaluation and management (E/M) code for new visits was 99205 (49%). The most commonly billed E/M code for established visits was 99213 (54%). Forty percent of providers billed none of their new office visits using 99205 (the highest E/M billing code), whereas 34% of providers billed all of their new office visits using 99205. For the 1510 radiation oncologists (37%) who billed technical services, median Medicare reimbursement was

Cost-effectiveness of prostate boost with high-dose-rate brachytherapy versus intensity-modulated radiation therapy in the treatment of intermediate-high risk prostate cancer

606,008, compared with

The business of integrative medicine in a large hospital system

93,921 for all other radiation oncologists (P<.001). On multivariate analysis, technical services billing (P<.001), male sex (P<.001), and rural location (P=.007) were predictive of higher Medicare reimbursement.nnnCONCLUSIONSnThe billing of technical services, with their high capital and labor overhead requirements, limits any comparison in reimbursement between individual radiation oncologists or between radiation oncologists and other specialists. Male sex and rural practice location are independent predictors of higher total Medicare reimbursements.

Comparing the Cost-Effectiveness of Low-Dose-Rate Brachytherapy, High-Dose-Rate Brachytherapy, and Hypofactionated Intensity Modulated Radiation Therapy for the Treatment of Low-/Intermediate-Risk Prostate Cancer

PURPOSEnMedicare payments to individual physicians are released annually by the CMS. The purpose of this study is to analyze trends in Medicare reimbursement and work relative value unit (wRVU) production to radiation oncologists.nnnMATERIALS AND METHODSnThe Medicare Physician Supplier and Other Provider Public Use File and the CMS Physician Fee Schedule Relative Value Files (to calculate wRVUs) for the calendar years 2012 to 2015 were used in this analysis. Medicare reimbursement was aggregated for each calendar year. Using the CMS Physician Fee Schedule Relative Value Files, the number of Medicare wRVUs was calculated for each radiation oncologist.nnnRESULTSnIn 2015, 4,323 radiation oncologists produced 12,895,298 wRVUs compared with 11,352,286 wRVUs produced in 2012. These datasets include only Medicare reimbursements and do not include wRVUs from private insurance or other payers. In 2015, radiation oncologists produced a median of 2,486 wRVUs from Medicare (range 3 to 24,349). Billing to Healthcare Common Procedure Coding System Code 77427 (radiation treatment management, five treatments), a proxy for total radiation treatments, fell from 1,111,670 in 2012 to 1,039,403 in 2015, a decline of 7%.nnnCONCLUSIONnThe total number of wRVUs produced by radiation oncologists has risen by 14% from 2012 to 2015. However, the number of external beam radiation fractions has declined by approximately 7% over this same period, likely due to a trend toward hypofractionated courses of treatment and use of special treatment modalities such as proton beam therapy or stereotactic body radiation therapy.

Poster ViewingTrends in Medicare Work Relative Value Unit (wRVU) Production in Radiation Oncology

Cancer is a major public health problem, and cancer patients and survivors face many physical and emotional challenges after the initial diagnosis, through treatment, and in the post-treatment period. Different integrative medicine (IM) modalities can be used to mitigate some of the physical issues that originate from the cancer itself or the treatment and to promote well-being and emotional health. Here, we discuss how an IM Department can function in a hospital system, particularly with regard to oncology patients, the modalities appropriate for oncology patients, how these modalities can benefit this patient population, and the role of IM in cancer survivorship. A dedicated IM Department that works with oncologists provides support and care for the whole person. These different modalities work together to reduce pain, anxiety, and chemotherapy-induced nausea and peripheral neuropathy, while promoting immune function and improving sleep, range of motion, and an overall sense of well-being. However, each modality has different contraindications for the oncology patient, and proper training is required for safe and effective care. We illustrate how IM can be a valuable component of the care of the oncology patient.

Poster ViewingCost-Effectiveness of Single-Fraction High-Dose Rate Brachytherapy versus Intensity Modulated Radiation Therapy for the Treatment of Low-Intermediate Risk Prostate Cancer

PURPOSEnThe recently published ASCENDE-RT randomized clinical trial demonstrated improved biochemical control, albeit with increased toxicity, for a prostate boost with brachytherapy versus external beam radiation therapy alone in patients with intermediate-high risk prostate cancer. In this study, we investigated the cost-effectiveness of these two modalities in the treatment of intermediate-high risk prostate cancer.nnnMETHODS AND MATERIALSnA multistate Markov model was created to model a patient with intermediate-high risk prostate cancer. The two treatment options modeled were (1) 23 fractions of intensity-modulated radiation therapy (IMRT) and two fractions of high-dose-rate prostate brachytherapy (brachytherapy boost) and (2) 44 fractions of IMRT (IMRT alone). Each patient received 1xa0year of hormone therapy, per the ASCENDE-RT protocol. Model assumptions, including clinical outcomes, toxicity, and utilities were derived from the medical literature. Costs of radiation therapy were estimated using Medicare reimbursement data.nnnRESULTSnThe estimated expected lifetime cost of brachytherapy boost was

Comparing the Costs of Robotic Prostatectomy and Radiation Therapy in Intermediate-Risk Prostate Cancer: Impact of the AUA/ASTRO Guidelines

68,696, compared to