Pioneering Radiation Oncology Episode Payment

DESCRIPTION

Whereas payment for radiotherapy treatment has historically been fee-for-service, Penn Medicine has pioneered episode-based payment: bundling payments for radiation services within a defined period of care as opposed to billing separately for each service.

Through a partnership and joint leadership with Independence Blue Cross (IBC), Penn Medicine launched the first global, prospective episode payment for radiation oncology services in the United States in August 2019. The Radiation Oncology Episode of Care (EOC) program initially focused on breast cancer, which ranks highest among cancers in terms of cost and where evidence-based guidelines endorse hypofractionation, or the delivery of fewer doses of radiotherapy over a shorter duration of time. IBC and Penn Medicine rolled out the EOC in phases to enhance bi-direction learning across clinical, quality, administrative burden, reimbursement, revenue cycle, and patient satisfaction domains.

IMPACT
The EOC program has been a success and now encompasses both commercial and Medicare Advantage IBC enrollees. IBC and Penn Medicine intend to expand the model.

PEOPLE
Danielle Hoffman; Katherine Madonna, CPA; Fabian Marechal, MS; James Metz, MD; Roy Schwartz, MBA; John McLean, MBA; David Miller, MBA; Larry Shulman, MD; Justin Bekelman, MD.

PARTNERS
Radiation Oncology, Penn Medicine Cancer Service Line, Penn Medicine, Independence Blue Cross

FOCUS
Payment Models and Affordability

PUBLICATION

Penn Medicine and Independence Blue Cross Renew Transformative Contract for Third Time

Getting the next version of payment policy “right” on the road toward accountable cancer care