Decreases in Radiation Oncology Medicare Reimbursement Over Time: Analysis by Billing Code

Hogan, Jacob; Roy, Amit; Karraker, Patricia; Pollock, Jordan R.; Griffin, Zachary D; Vapiwala, Neha; Bradley, Jeffrey D.; Pérez, Carlos A.; Fischer‐Valuck, Benjamin W.; Baumann, John C.; Baumann, Brian C.

doi:10.1016/j.ijrobp.2022.05.018

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…Yet, despite these economic considerations, the overall number of fractions per course of therapy has decreased over time 16,17 and Medicare expenditures on RT services have plateaued. 18 Within our specialty, there is increasing focus on delivering cost-effective therapies offering meaningful benefits 19 although certainly there remains much room for improvement in optimizing the cost benefit ratio for RT.…”

Section: When Less Is More and When Less May Be Lessmentioning

confidence: 99%

Re-Examining Trials of Radiotherapy Omission: When Less Is Not Always More

Sanford,

Hall,

Booth

2024

JCO Oncol Pract

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Section: When Less Is More and When Less May Be Lessmentioning

confidence: 99%

Re-Examining Trials of Radiotherapy Omission: When Less Is Not Always More

Sanford,

Hall,

Booth

2024

JCO Oncol Pract

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“…Limitations include the use of controls with IMRT use that varied substantially from nationally representative data, 8,9 use of a single practice in the exposure group, 10 and cross-sectional study design. 7 Because of high ownership costs 11 and decreased reimbursement of IMRT over the last decade, [12][13][14] some practices have divested their ownership stake. Examining whether such divestment affects the management of men with prostate cancer would further clarify the extent to which financial incentives associated with ownership influence physician behavior, particularly in the most discretionary contexts, where the benefits of immediate treatment are less certain.…”

Section: Introductionmentioning

confidence: 99%

Urologist practice divestment from radiation vault ownership and treatment patterns for prostate cancer

Faraj,

Kaufman,

Herrel

et al. 2023

Cancer

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BackgroundUrologists practicing in single‐specialty groups with ownership in radiation vaults are more likely to treat men with prostate cancer. The effect of divestment of vault ownership on treatment patterns is unclear.MethodsA 20% sample of national Medicare claims was used to perform a retrospective cohort study of men with prostate cancer diagnosed between 2010 and 2019. Urology practices were categorized by radiation vault ownership as nonowners, continuous owners, and divested owners. The primary outcome was use of local treatment, and the secondary outcome was use of intensity‐modulated radiation therapy (IMRT). A difference‐in‐differences framework was used to measure the effect of divestment on outcomes compared to continuous owners. Subgroup analyses assessed outcomes by noncancer mortality risk (high [>50%] vs. low [≤50%]).ResultsAmong 72 urology practices that owned radiation vaults, six divested during the study. Divestment led to a decrease in treatment compared with those managed at continuously owning practices (difference‐in‐differences estimate, −13%; p = .03). The use of IMRT decreased, but this was not statistically significant (difference‐in‐differences estimate, −10%; p = .13). In men with a high noncancer mortality risk, treatment (difference‐in‐differences estimate, −28%; p < .001) and use of IMRT (difference‐in‐differences estimate, −27%; p < .001) decreased after divestment.ConclusionsUrology group divestment from radiation vault ownership led to a decrease in prostate cancer treatment. This decrease was most pronounced in men who had a high noncancer mortality risk. This has important implications for health care reform by suggesting that payment programs that encourage constraints on utilization, when appropriate, may be effective in reducing overtreatment.

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“…2 In this issue of the Red Journal, Hogan et al now report the curve may be pointed downward into negative growth. 3 Second, we learned that in the years that followed, radiation oncologists readily developed and adopted treatments that were more convenient and lower cost for the patient-and these innovations were supported by the American Society for Radiation Oncology and other academic radiation oncology societies. 4 Third, we learned that all around us, the costs of prescription medications, pathology, laboratories, and health care in general have continued to rise.…”

mentioning

confidence: 99%

The RO-APM: The Wrong Solution to the Wrong Problem

2022

International Journal of Radiation Oncology*Biology*Physics

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Decreases in Radiation Oncology Medicare Reimbursement Over Time: Analysis by Billing Code

Cited by 6 publications

References 20 publications

Re-Examining Trials of Radiotherapy Omission: When Less Is Not Always More

Re-Examining Trials of Radiotherapy Omission: When Less Is Not Always More

Urologist practice divestment from radiation vault ownership and treatment patterns for prostate cancer

The RO-APM: The Wrong Solution to the Wrong Problem

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