Analysis of Medicare Reimbursement Trends in Medical and Radiation Oncology.

Abstract

Purpose: Radiation and medical oncology face pressure from payment changes, which aim to increase the value of care and curb rising spending. Multiple models have been proposed or implemented, with mixed results for cost saving and financial stability. While previous studies have quantified changes in Medicare reimbursement for radiation oncology on a per-code basis, this has not been done in medical oncology to our knowledge, and no direct comparisons have been made between oncology subspecialties at this level. Our study aims to quantify and analyze Medicare reimbursement changes for medical and radiation oncology billing codes.

Materials/methods: In this longitudinal study of reimbursement, the publicly available Physician/Supplier Procedure Summary database was used to obtain Medicare reimbursement data for 2010, 2016, and 2020. All reimbursement for providers with primary provider codes 92 (radiation oncology), 83 (hematology oncology), and 90 (medical oncology) were analyzed, combining hematology and medical oncology. Inflation- and utilization-adjusted changes in reimbursement were calculated from 2010-2020 and 2016-2020 on a per-code basis with results grouped by specialty and billing category.

Results: From 2010-2020, inflation- and utilization-adjusted Medicare reimbursement decreased by $1.2B (-16%) for all codes, $705M (-29%) for radiation oncology-specific codes, and $541M (-10%) for medical oncology-specific codes. From 2016-2020, inflation- and utilization-adjusted reimbursement decreased by $299M (-3%) for all codes, $108M (-5.6%) for radiation oncology-specific codes, and $191M (-2.2%) for medical oncology-specific codes. Chemotherapy (-40%) and radiotherapy (-33%) saw the largest decreases in inflation- and utilization-adjusted reimbursement from 2010-2020, while immunotherapy (+21%) saw the largest increase.

Conclusions: Our analysis shows continually decreasing Medicare reimbursement for both radiation and medical oncology from 2010-2020 and 2016-2020. This decade-long continuous decline highlights the need for payment system stabilization-whether through episode-based payment models or another avenue.