Trends in American Radiation Oncology Workforce, Patient Volume and Technology Utilization

Abstract

<h3>Purpose/Objective(s)</h3> Concerns have arisen within the US radiation oncology (RO) community regarding the current workforce supply-demand imbalance and the future impact of the Centers for Medicare and Medicaid Services (CMS) alternative payment model (APM) on reimbursement and practice patterns. We evaluated trends in RO providers and technology utilization before the RO-APM implementation based on CMS data. <h3>Materials/Methods</h3> We used publicly available CMS Physician and Other Provider Public Use Files from 2012 to 2019. We identified RO providers by the "provider type" field. New patient visits (NPVs) were determined by the 99203, 99204, 99205 CPT codes, treatment plans by the 77261, 77262, and 77263 CPT codes, and on-treatment visits (OTVs) by the 77427, 77431, 77432, and 77435 CPT codes. The total number of yearly fractions per RT modality was defined by relevant CPT codes. We report descriptive statistics and trends in these metrics. These numbers do not include patients enrolled on Medicare Advantage plans, the prevalence of which has increased over the study period. <h3>Results</h3> From 2012 to 2019, the number of RO providers per year in the CMS database increased from 4,135 to 4,612 (+11.5%); the number of Medicare NPVs per year by provider increased by 17% over the same time (220,569 to 257,408). Consequently, the ratio of new patients per provider per year increased slightly (+4.6%); in contrast, the number of treatment plans per provider per year declined (-5.3%). <b>Table 1</b> shows these data numerically. The number of IMRT fractions per year slightly declined (-5.1%); the total number of proton and SBRT/SRS fractions per year increased by 343% and 182%, respectively. Total 3D conformal radiotherapy fractions per year nearly halved (-41%). The number of OTVs per treatment plan declined annually, suggesting a decrease in treatment duration (4.3 to 3.8, -7.3%). In absolute terms, Medicare payments to RO providers declined marginally from 2012 ($1.50 billion USD) to 2019 ($1.43 billion USD); but, when accounting for inflation, this resulted in a 14% decline in RO reimbursement from CMS. <h3>Conclusion</h3> The stable ratio of new patient visits to RO providers suggests that, as of 2019, growth in patient volume resembles growth in ROs; however, there has been an uncoupling of increase in NPVs and treatment plans that may reflect increased omission of RT in situations where RT was previously utilized. RO reimbursement declined before the introduction of the RO-APM. Upon enacting the RO-APM, the appropriate use of technology and hypofractionated courses should be closely monitored in the setting of monetary incentives.