International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationVariations in Medicare Reimbursement in Radiation Oncology: An Analysis of the Medicare Provider Utilization and Payment Data Set
Introduction
In April 2014, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF), which for the first time detailed Medicare reimbursement to individual physicians. There was extensive media coverage of this release, with particular attention paid to the highest reimbursed providers, many of whom were radiation oncologists 1, 2, 3. The release of this data set reflects CMS's larger mandate to increase transparency in health care, with the goal of reducing health care costs while maintaining high-quality care (4). Analyses of the POSPUF have been previously published in other specialties, including otolaryngology, gastroenterology, neurology, and urology 5, 6, 7, 8. The purposes of this study are to summarize the POSPUF in radiation oncology, analyze the data, and explain the factors that contribute to variations in Medicare reimbursement.
Section snippets
Physician payment data set
The CMS published the POSPUF on April 8, 2014 (9). The methodology used in the POSPUF is described in detail on the CMS website (10). In summary, the POSPUF contains data on nearly all Medicare part B line items in 2012. The data are listed by Healthcare Common Procedure Coding System (HCPCS) codes for each individual provider, identified by their National Provider Identifier (NPI) code. For each NPI, brief demographic information, including the provider's name, credentials, sex, and address,
Results
There were 4135 radiation oncologists who received payments from Medicare in 2012 totaling $1,499,625,803. Seventy-five percent of listed radiation oncologists were male. The median reimbursement was $146,453 (interquartile range: $69,787-$423,356). The median number of unique Medicare beneficiaries treated was 179, and the median number of services provided was 2007. The median number of office E/M visits was 150, with reimbursement of $10,345.
A total of 616 distinct HCPCS codes were
Discussion
The high Medicare reimbursement to radiation oncologists was highlighted in numerous news articles covering the release of the POSPUF 2, 3. Our analysis shows the inherent limitations of such comparisons. Most Medicare “reimbursement” to radiation oncologists was for technical services, which have significantly higher overhead costs than professional services. When only professional fees were included, the average Medicare reimbursement to radiation oncologists is comparable with that of other
Conclusions
In conclusion, this analysis of the POSPUF in radiation oncology highlighted the significant limitations in comparing reimbursements between individual radiation oncologists and between radiation oncologists and other physicians, given the high overhead costs of technical services in radiation oncology. However, there exist sex and rurality differences in reimbursement, independent of the billing of technical services, which are explained by differences in patient volumes. There is significant
References (16)
- et al.
No association between Centers for Medicare and Medicaid Services payments and volume of Medicare beneficiaries or per-capita health care costs for each state
Clin Gastroenterol Hepatol
(2015) - et al.
Variability in Medicare utilization and payment among urologists
Urology
(2015) - et al.
Radiation oncologists in the United States
Int J Radiat Oncol
(2007) - Carreyrou J, Stewart CS, Barry R. Taxpayers face big Medicare tab for unusual doctor billings. The Wall Street Journal....
- Weaver C, McGinty T, Radnofsky L. Small slice of doctors account for big chunk of Medicare costs. The Wall Street...
- Abelson R, Cohen S. Sliver of Medicare doctors get big share of payouts. The New York Times. Available at:...
- et al.
The Medicare physician-data release—Context and rationale
N Engl J Med
(2014) - et al.
Characteristics of otolaryngology claims to Medicare in 2012
Otolaryngol Head Neck Surg
(2014)
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Conflict of interest: none.