Impact of the Radiation Oncology Alternative Payment Model on Brachytherapy Reimbursement.

PURPOSE: The Radiation Oncology Alternative Payment Model (RO Model) will test prospective radiotherapy episode-based payments for 16 common disease sites. We created an automated analytics platform to calculate the impact of the RO Model vs historical fee-for-service episode reimbursements for brachytherapy treatments within five community oncology practices for prostate, uterine, and cervical cancer. METHODS AND MATERIALS: Claims data between January 1, 2017 and October 2, 2019 for prostate, uterine, and cervical cancer were analyzed as per the RO Model Final Rule methodology. Expected professional and technical component (PC and TC) reimbursements were compared for episodes that utilized brachytherapy alone vs combination modality (external beam and brachytherapy) in the RO Model vs historical reimbursements. RESULTS: 6,022 RO Model-defined episodes (60% prostate, 28% uterine, 13% cervical) were generated. Brachytherapy monotherapy episodes (14%) would have an average positive reimbursement in the RO Model (+$2,163 for prostate, +$711 for uterine, +$533 for cervical for the PC; +$12,168 for prostate, +$8,181 for uterine, +$11,322 for cervical for the TC), while combination modality episodes (15%) would have an average negative reimbursement in the RO Model (-$183 for prostate, -$1,701 for uterine, -$2,195 for cervical for the PC; -$374 for prostate, -$5,026 for uterine, -$2,801 for cervical for the TC). CONCLUSIONS: Brachytherapy monotherapy episodes for prostate, uterine, and cervical cancer will benefit from an increase in payment, whereas combination modality episodes will receive lower reimbursement. Large shifts in episodic payment may be related to practice-wide adjustments and pricing based on partial episodes of care that may ultimately limit access to care for vulnerable patient populations with cancer.

Climate-induced changes in continental-scale soil macroporosity may intensify water cycle.

Soil macroporosity affects field-scale water-cycle processes, such as infiltration, nutrient transport and runoff1,2, that are important for the development of successful global strategies that address challenges of food security, water scarcity, human health and loss of biodiversity3. Macropores-large pores that freely drain water under the influence of gravity-often represent less than 1 per cent of the soil volume, but can contribute more than 70 per cent of the total soil water infiltration4, which greatly magnifies their influence on the regional and global water cycle. Although climate influences the development of macropores through soil-forming processes, the extent and rate of such development and its effect on the water cycle are currently unknown. Here we show that drier climates induce the formation of greater soil macroporosity than do more humid ones, and that such climate-induced changes occur over shorter timescales than have previously been considered-probably years to decades. Furthermore, we find that changes in the effective porosity, a proxy for macroporosity, predicted from mean annual precipitation at the end of the century would result in changes in saturated soil hydraulic conductivity ranging from -55 to 34 per cent for five physiographic regions in the USA. Our results indicate that soil macroporosity may be altered rapidly in response to climate change and that associated continental-scale changes in soil hydraulic properties may set up unexplored feedbacks between climate and the land surface and thus intensify the water cycle.