Trends in Medicare Reimbursement and Work Relative Value Unit Production in Radiation Oncology

• Published in: Journal of the American College of Radiology Vol. 15; no. 6; pp. 870 - 875
• Main Authors: Vu, Charles C., Lanni, Thomas B., Nandalur, Sirisha R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2018
• Subjects: Centers for Medicare and Medicaid Services (U.S.); Fee Schedules; Humans; Medicare; Medicare - economics; payments; Radiation Oncology - economics; reimbursement; Reimbursement Mechanisms - economics; Relative Value Scales; United States; work relative value unit; wRVU; United States; reimbursement; Medicare; wRVU; work relative value unit; payments
• ISSN: 1546-1440; 1558-349X
• DOI: 10.1016/j.jacr.2018.02.005

Medicare payments to individual physicians are released annually by the CMS. The purpose of this study is to analyze trends in Medicare reimbursement and work relative value unit (wRVU) production to radiation oncologists. The Medicare Physician Supplier and Other Provider Public Use File and the CMS Physician Fee Schedule Relative Value Files (to calculate wRVUs) for the calendar years 2012 to 2015 were used in this analysis. Medicare reimbursement was aggregated for each calendar year. Using the CMS Physician Fee Schedule Relative Value Files, the number of Medicare wRVUs was calculated for each radiation oncologist. In 2015, 4,323 radiation oncologists produced 12,895,298 wRVUs compared with 11,352,286 wRVUs produced in 2012. These datasets include only Medicare reimbursements and do not include wRVUs from private insurance or other payers. In 2015, radiation oncologists produced a median of 2,486 wRVUs from Medicare (range 3 to 24,349). Billing to Healthcare Common Procedure Coding System Code 77427 (radiation treatment management, five treatments), a proxy for total radiation treatments, fell from 1,111,670 in 2012 to 1,039,403 in 2015, a decline of 7%. The total number of wRVUs produced by radiation oncologists has risen by 14% from 2012 to 2015. However, the number of external beam radiation fractions has declined by approximately 7% over this same period, likely due to a trend toward hypofractionated courses of treatment and use of special treatment modalities such as proton beam therapy or stereotactic body radiation therapy.