Radiation Oncology Utilization in the IMRT Era

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Department of Radiation Oncology:

Rani Anne, MD

Tim Showalter, MD

Mark Mishra, MD

Department of Radiology:

Laurence Parker, PhD

David Levin, MD

Vijay Rao, MD

School of Population Health:

Sanford Barth, PhD


We evaluated long-term changes in the volume and payments for radiation oncology services in the intensity modulated radiation therapy (IMRT) era from 2000 to 2010, using a database of Medicare claims files. We used the Medicare Physician/Supplier Procedure Summary Master File (PSPSMF) for each year from 2000 to 2010 to tabulate the volume and payments for radiation oncology services. This database provides a summary of each billing code submitted to Medicare part B. We identified all codes used in radiation oncology services and categorized billing codes by treatment modality and place of service. We focused our analysis on office-based practices, which provide approximately half of all radiation oncology services. Total office-based patient volume increased 8.2% from 2000 to 2010, while total payments increased 217%. Increase in overall payments increased dramatically from 2000 to 2007, but subsequently plateaued. IMRT accounted for 52% of external beam treatment delivery, and 70% of treatment delivery payments by 2010. Increases in complexity of care, and image guidance in particular, have also increased cost. Office-based practices have greater utilization of IMRT than hospital-based outpatient practices. Cost of radiation oncology services increased from 2000 to 2010, mostly due to IMRT, but also with significant contribution from increased overall complexity of care. A bend in the cost curve occurred after 2007, limiting further growth of payments. Future health policy studies should explore the potential for further cost containment, including differences in utilization between free standing and hospital outpatient facilities.

Presentation: 26 minutes