Patterns in Medicare Payments to Radiation Oncologists

Abstract

Contemporary payment patterns to radiation oncologists (ROs) in the United States are poorly described. We aimed to characterize patterns and predictors of Medicare payments to ROs. We hypothesized that both provider and beneficiary characteristics would predict for Medicare payment amounts. We used the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF) from 2015 to examine the most recent trends in provider reimbursement. ROs who submitted claims to Medicare in 2015 were included in our analysis. Primary outcome variables included total Medicare payment amount and Medicare payment amount per beneficiary for each provider in the POSPUF database. Univariate analyses were performed to assess for correlations with provider gender, credentials, and state of practice as well as beneficiary age, gender, race, and dual Medicare/Medicaid entitlement status. Linear regression models assessed the relationship between primary outcome variables and continuous covariates. ANOVA and two-sample t-test assessed the relationship between primary outcome variables and categorical covariates. In 2015, 4,419 providers were classified as ROs by the Centers for Medicare and Medicaid Services. Among these providers, a total of $1,527,486,910 was paid by Medicare. Total Medicare payments averaged $345,663 per RO (range $494-$5,400,123; SD $500,154. Medicare payments per beneficiary averaged $1,667 per RO (range $16-$26,886; SD $2,150). With respect to total Medicare payments, female ROs were reimbursed less than male ROs ($242,319 vs $381,763, p<0.001) and ROs with a MD degree alone were reimbursed more than ROs with combined or other degrees ($355, 860 vs $261,275, p<0.001). Total Medicare payments at the provider-level increased by $54,527 (SE 3308.48, p<0.001) for each year increase in beneficiary age, increased by $433 (SE 50.99, p<0.001) for each additional female beneficiary treated, and increased by $696 (SE 42.89, p<0.001) for each additional white, non-Hispanic beneficiary treated. Total Medicare payments were not significantly influenced by Asian, Black, or Hispanic race, dual Medicare/Medicaid entitlement, or practice state of the provider. In terms of Medicare payments per beneficiary, the above predictors remained significant, but Black race (-$2, SE 0.58, p<0.001), dual Medicare/Medicaid entitlement (-$2, SE 0.33, p<0.001), and practice state of the provider also emerged as significant predictors of payment. Provider male sex and non-combined MD degree are independent predictors of higher total Medicare payments. Beneficiary age, non-Hispanic white race, and female sex also predicted for higher total payments. Further study is required to determine the extent to which these contemporary reimbursement patterns are driven by variations in billing for technical services, patient volume, or gaps in opportunities for economic advancement within the specialty.