Drivers of Medicare Spending: A 20-Year Review of Radiation Oncology Charges Allowed per Person as Compared to Other Specialties

ABSTRACT

The rising cost of health care is a major concern in the United States. Though radiation oncology was targeted for cost reductions based on expenditure growth, subsequent analyses suggested stabilization of radiation oncology charges. In 2019, the Centers for Medicare and Medicaid Services (CMS) proposed a new radiation oncology model aimed at further reducing Medicare expenditures while potentially improving the quality of beneficiary care. In 2020, CMS issued a final rule establishing a Radiation Oncology Alternative Payment Model to begin Jan 1, 2022, although this was delayed to Jan 1, 2023 through the Supporting Health Care Providers During the COVID-19 Pandemic Act. We examined changes in aggregate Medicare charges allowed per person served and per Part B Enrollee to provide contemporary context to proposed changes and hypothesize that radiation oncology charges remained stable from 1999 through 2019. Medicare physicians/suppliers' utilization, program payments and balance billing for original Medicare beneficiaries, by physician specialty, was analyzed from 1999 to 2019 through CMS program statistics. Total allowed physician charges per person with utilization, cost per original Medicare part B enrollee, inflation adjusted charges, and percent of total charges billed per specialty were examined, including hospital-based physician charges and free-standing center global charges. We adjusted for inflation using the consumer price index for medical care from the US Bureau of Labor Statistics. The average allowed charges per person served went from $2,065 in 1999 to $2,260 in 2019, when adjusting for inflation. The top three specialties accounting for the most charges per person served in 2019 were Hematology-Oncology, Medical Oncology, and Radiation Oncology with $1,706, $1,485, and $1,336 charges allowed per person served, respectively. Radiation oncology charges allowed by Medicare per person served decreased by 7% from 1999 to 2004 ($1,283 to $1,199), increased by 32% from 2004 to 2009 (from $1,199 to $1,588), decreased 3% from 2009 to 2014 ($1,588 to $1,544), and decreased another 13% from 2014 to 2019 ($1,544 to $1,336), when adjusted for inflation. Radiation oncology charges allowed per original Medicare part B enrollee was $53, or 1.4% of the $3,937 total for all specialties in 2019. Oncology charges allowed by Medicare per person served are among the highest of all specialties. Radiation oncology physician charges per person served have decreased steadily from 2009 to 2019. Charges per original Medicare Part B enrollee represent a small fraction of total Medicare fee-for-service physician/supplier expenses. Thus, the need for an alternative payment model as a method to control radiation oncology physician charges may be overstated. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)