Laurence Parker PhD, Abstract Co-Author: Nothing to Disclose

Pramila Rani Anne MD, Presenter: Nothing to Disclose

David C. Levin MD, Abstract Co-Author: Consultant, HealthHelp Board of Directors, Outpatient Imaging Affiliates, LLC

Vijay Madan Rao MD, Abstract Co-Author: Nothing to Disclose

This study examines utilization of radiation oncology procedures in the Medicare population. Diagnostic imaging has received some scrutiny in recent years, because of rapid increases in the utilization of high-technology, high-cost imaging modalities and potential self-referral issues in specialties outside of radiology. Similar issues exist in radiation oncology, but they have not been studied extensively.

The data sources for this study were the Centers for Medicare and Medicaid Services Physician/Supplier Procedure Summary Master Files for 1998 through 2008, which record national Medicare procedure volume for each procedure code for Medicare fee-for-service beneficiaries. We extracted records for 60 radiation oncology procedure codes, and grouped them by major headings in the CPT-4 procedure manual. We tabulated the number of procedures performed in each category as well as the dollar amount in allowed charges. We calculated percentage change from earlier to later years. We also examined the percentage of procedures performed by radiation oncologists and radiologists vs. other specialties.

Overall radiation oncology volume increased moderately, from 7,230,566 procedures in 1998 to 10,217,330 in 2008, a 41% increase. However, Medicare allowed charges increased 156% from $759 M. to $1.94 B. Radiation Treatment Delivery increased from 2,690,233 to 3,573,902 procedures, a 33% increase in utilization. However, allowed charges increased 409% from $198 M. to $1.01 B. Intensity Modulated Radiation Therapy, IMRT, increased from 115,252 procedures in 2002 (when the procedure code was introduced) to 1,188,907 procedures in 2008, a 930% increase; Image Guided Radiation Therapy, IGRT, increased 175% from 274,241 procedures in 2006 to 753,912 procedures in 2008. Radiation oncologist (87%) / radiologist (6%) share was 93% in 2008, and greater than 89% in all categories.

While growth in volume of radiation oncology procedures has been moderate from 1998 to 2008, Medicare payments have increased rapidly. This is due to enormous growth in IMRT and IGRT procedures in recent years. Benefits and costs of these procedures deserve careful attention. While radiation oncologist / radiologist share is high, the potential for other specialties to self-refer for very costly procedures should be further explored.

N.A.

Parker, L, Anne, P, Levin, D, Rao, V, Utilization of Radiation Oncology Procedures in the Medicare Population: 1998-2008.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9009032.html