Cost neutrality.

Who doesn’t have a proton center these days? What used to be a sparsely-available treatment with referrals reserved for cases with the most obvious benefit has become the latest fixture for centers looking to put out a new billboard campaign. Who’s been getting proton treatments in droves with this recent rise in proton centers? Patients insured by Medicare, of course. Enter the RO-APM promising to bundle payments in a manner blinded to treatment modality, turning a cold shoulder to the fact it costs centers 2-3x more to deliver protons compared to photons. Having served a large catchment area with a single proton gantry in the early days of their proton center, the University of Maryland is ahead of the APM-curve by pioneering a “cost-neutral” clinical benefit score (CBS) to prioritize patients for protons based on—who would’ve thought—clinical indications rather than ability to pay. These indications consider disease site, retreatment, organs-at-risk dosimetry, and protocol enrollment. TBL: With ability to pay now being a “no” pretty much across the board, a tool such as the CBS may be a helpful tool in deciding who should receive proton therapy. | Sharma, Cureus 2019