Shen Xinglei, Showalter Timothy N, Mishra Mark V, Barth Sanford, Rao Vijay, Levin David, Parker Laurence
University of Kansas Medical Center, Kansas City, KS; Thomas Jefferson University, Philadelphia, PA; and University of Maryland, Baltimore, MD
University of Kansas Medical Center, Kansas City, KS; Thomas Jefferson University, Philadelphia, PA; and University of Maryland, Baltimore, MD.
J Oncol Pract. 2014 Jul;10(4):e201-7. doi: 10.1200/JOP.2013.001270. Epub 2014 Apr 22.
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.
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. Total office-based patient volume increased 8.2% from 2000 to 2010, whereas total payments increased 217%. Increase in overall payments increased dramatically from 2000 to 2007, but subsequently plateaued from 2008 to 2010. Increases in complexity of care, and image guidance in particular, have also resulted in higher payments.
The 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 cost adjustment occurred after 2007, limiting further growth of payments. Future health policy studies should explore the potential for further cost containment, including differences in use between freestanding and hospital outpatient facilities.
我们利用医疗保险索赔数据库评估了2000年至2010年调强放射治疗（IMRT）时代放射肿瘤学服务的数量和支付费用的长期变化。
我们使用2000年至2010年每年的医疗保险医师/供应商程序汇总主文件（PSPSMF）来统计放射肿瘤学服务的数量和支付费用。该数据库提供了提交给医疗保险B部分的每个计费代码的摘要。我们确定了放射肿瘤学服务中使用的所有代码，并按治疗方式和服务地点对计费代码进行了分类。
我们将分析重点放在基于办公室的实践上。从2000年到2010年，基于办公室的患者总数增加了8.2%，而支付总额增加了217%。从2000年到2007年，总支付额的增长急剧增加，但随后在2008年到2010年趋于平稳。护理复杂性的增加，尤其是图像引导，也导致了更高的支付费用。
从2000年到2010年，放射肿瘤学服务的成本增加了，主要是由于IMRT，但护理总体复杂性的增加也有很大贡献。2007年后发生了成本调整，限制了支付费用的进一步增长。未来的卫生政策研究应探索进一步控制成本的潜力，包括独立设施和医院门诊设施在使用上的差异。
