Comparing Changes in Medicare Reimbursement for Radiation Oncology and Medical Oncology (2010-2020)

PURPOSE/OBJECTIVE(S)

A recent study found that radiation oncology (RO) has seen significant declines in Medicare reimbursement (MCR) from 2010-2019. While it is presumed that other cancer subspecialties have seen decreasing MCR, to our knowledge, there are no studies directly comparing changes in MCR between RO and other oncology subspecialties. In this study, we analyze changes in MCR from 2010-2020 for both RO and medical oncology. We hypothesized that the declines in MCR will be similar between the two fields.

MATERIALS/METHODS

The publicly available Physician/Supplier Procedure Summary (PSPS) database was used for all years from 2010-2020. All reimbursement for providers with primary provider codes 92 (RO) and 83 and 90 (heme/onc and medical oncology, respectively) were analyzed. For the 150 most highly-reimbursed HCPCS codes for each specialty in 2010, the total allowed charge for each code was corrected for inflation and then divided by the number of submitted claims to calculate average MCR per code for each year. For each code and each specialty, the 2020 billing frequency was multiplied by the calculated average reimbursement per claim in a given year to calculate what the reimbursement would have been in that year using 2020 dollars and utilization rates (projected reimbursement). The projected reimbursement was summed for all HCPCS codes in each year for each specialty to calculate an aggregate MCR for that specialty for that year. This aggregate MCR was then compared with the actual 2020 reimbursement for that basket of codes to calculate the change in MCR over time.

RESULTS

Both medical and radiation oncology saw decreases in projected vs. actual MCR from 2010-2020 for this basket of services (Table). Adjusting for inflation and utilization, RO MCR declined by $0.7 billion (B) (-29.0%) from 2010 to 2020 and by $0.2B (-10.5%) from 2015 to 2020 while medical oncology MCR declined by $0.8B (-14.7%) from 2010-2020 and by $0.4B (-6.6%) from 2015-2020. The average decrease per year in projected vs. actual reimbursement for RO was 2.9% (2010 to 2015) and 1.05% (2015 to 2020) and for medical oncology was 1.5% (2010-2015) and 0.7% (2015-2020), respectively.

CONCLUSION

Adjusting for inflation, Medicare reimbursement for a large array of services has declined for both medical oncology and RO from 2010 - 2020. Contrary to our hypothesis, RO reported a 97% greater relative decline in reimbursement compared with medical oncology from 2010 - 2020. Significant decreases in reimbursement to both fields and their potential implications on patient care and access to care should be considered by policymakers while shifting towards an episode-based Alternative Payment Model and when considering further cuts to Medicare reimbursement.