Community Care Radiation Oncology Cost Calculations for a VA Medical Center

Veterans can now access specialized care normally delivered at large tertiary US Department of Veterans Affairs (VA) medical centers (VAMCs). The costs are paid by their originating VAMC, but have not been comprehensively examined.

This study analyzes radiation oncology community care consultations, authorizations, standard episodes of care (SEOCs), and radiation oncology-specific charges at the Richard L. Roudebush VAMC (RLRVAMC) to provide a comprehensive view of the financial effects of sending patients to community care. It also demonstrates obstacles in categorization and suggests improvements to current VA practices.

From October 1, 2021, to February 1, 2024, about $2.7 million was spent by RLRVAMC on community care radiation oncology services, with median SEOC charges of $5000. After accounting for inadvertently omitted radiation oncology costs and patients, total expenditures are closer to $2.9 million. The median cost of the consultation increased to $20,600 for patients who received community-based definitive radiation treatment.

Current methods for calculating community-based radiation oncology costs underestimate total expenditures, exclude some patients who receive radiotherapy services, and severely understate the median cost of care for those undergoing definitive treatment.