PMID- 30677470
OWN - NLM
STAT- MEDLINE
DCOM- 20191219
LR  - 20191219
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 104
IP  - 4
DP  - 2019 Jul 15
TI  - Differences in United States Insurance Payer Policies and American Society for 
      Radiation Oncology's (ASTRO) Model Policy on Stereotactic Body Radiation Therapy 
      (SBRT).
PG  - 740-744
LID - S0360-3016(19)30040-9 [pii]
LID - 10.1016/j.ijrobp.2019.01.005 [doi]
AB  - PURPOSE: Insurance payers in the United States vary in the indications for which 
      they consider stereotactic body radiation therapy (SBRT) "medically necessary." 
      We compared changes in policies after the last update to the American Society for 
      Radiation Oncology's (ASTRO) SBRT model policy. METHODS AND MATERIALS: We 
      identified 77 payers with SBRT policies in 2015 from a policy aggregator, as well 
      as 4 national benefits managers (NBMs). Of these, 65 payers and 3 NBMs had 
      publicly available updates since 2015. For each of the indications in ASTRO's 
      model policy, we calculated the proportion of payers that considered SBRT 
      medically necessary. We used Fisher's exact test to compare these proportions 
      between 2015 and now, between policies updated in the past 12 months and those 
      updated less often, and between national and regional payers currently. RESULTS: 
      Payers consider SBRT medically necessary most often for primary lung cancer 
      (97%), reirradiation to the spine (91%), prostate cancer (68%), primary liver 
      cancer (66%), and spinal metastases with radioresistant histologies (66%). 
      Policies have become more aligned with ASTRO's model policy over time. National 
      payers and NBMs cover indications in higher proportions than regional payers. 
      CONCLUSIONS: Although there have been improvements over time, more work is needed 
      to align payer policies with ASTRO's model SBRT policy, especially at the 
      regional level.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Roach, Michael C
AU  - Roach MC
AD  - Department of Radiation Oncology, Washington University School of Medicine, St 
      Louis, Missouri. Electronic address: roachm@wustl.edu.
FAU - Thomas, Tarita O
AU  - Thomas TO
AD  - Department of Radiation Oncology, Loyola University Chicago Stritch School of 
      Medicine, Chicago, Illinois.
FAU - Paravati, Anthony J
AU  - Paravati AJ
AD  - Department of Radiation Oncology, Kettering Medical Center, Kettering, Ohio.
FAU - Mahajan, Anita
AU  - Mahajan A
AD  - Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
LA  - eng
PT  - Journal Article
DEP - 20190121
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
CIN - Int J Radiat Oncol Biol Phys. 2019 Jul 15;104(4):745-747. PMID: 31204660
MH  - Benchmarking
MH  - Humans
MH  - Insurance Claim Review/standards
MH  - Insurance Coverage/standards
MH  - Insurance, Health, Reimbursement/*standards/statistics & numerical data
MH  - Neoplasms/*radiotherapy
MH  - *Organizational Policy
MH  - Radiation Oncology/*standards/statistics & numerical data
MH  - Radiosurgery/*economics
MH  - Societies, Medical/*standards
MH  - United States
EDAT- 2019/01/25 06:00
MHDA- 2019/12/20 06:00
CRDT- 2019/01/25 06:00
PHST- 2018/09/11 00:00 [received]
PHST- 2019/01/01 00:00 [revised]
PHST- 2019/01/08 00:00 [accepted]
PHST- 2019/01/25 06:00 [pubmed]
PHST- 2019/12/20 06:00 [medline]
PHST- 2019/01/25 06:00 [entrez]
AID - S0360-3016(19)30040-9 [pii]
AID - 10.1016/j.ijrobp.2019.01.005 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2019 Jul 15;104(4):740-744. doi: 
      10.1016/j.ijrobp.2019.01.005. Epub 2019 Jan 21.