Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
Int J Radiat Oncol Biol Phys. 2021 Jun 1;110(2):322-327. doi: 10.1016/j.ijrobp.2020.12.051. Epub 2021 Jan 4.
In 2019, the Centers for Medicare and Medicaid Services proposed a new radiation oncology alternative payment model aimed at reducing expenditures. We examined changes in aggregate physician Medicare charges allowed per specialty to provide contemporary context to proposed changes and hypothesize that radiation oncology charges remained stable through 2017.
Medicare physician/supplier utilization, program payments, and balance billing for original Medicare beneficiaries, by physician specialty, were analyzed from 2002 to 2017. Total allowed charges under the physician/supplier fee-for-service program, inflation-adjusted charges, and percent of total charges billed per specialty were examined. We adjusted for inflation using the consumer price index for medical care from the US Bureau of Labor Statistics.
Total allowed charges increased from $83 billion in 2002 to $138 billion in 2017. The specialties accounting for the most charges billed to Medicare were internal medicine and ophthalmology. Radiation oncology charges accounted for 1.2%, 1.6%, and 1.4% of total charges allowed by Medicare in 2002, 2012, and 2017, respectively. Radiation oncology charges allowed increased 44% from 2002 to 2012 ($987.6 million to $1.42 billion) but decreased by 19% from 2012 to 2017 ($1.15 billion), adjusted for inflation. Total charges allowed by internal medicine decreased 2% from 2002 to 2012 ($8.53 to $8.36 billion), adjusted for inflation, and decreased 16% from 2012 to 2017 ($7.05 billion). When adjusting for inflation, ophthalmology charges increased 18% from 2002 to 2012 ($4.53 to $5.36 billion) and increased 3% from 2012 to 2017 ($5.5 billion).
Radiation oncology physician charges represent a small fraction of total Medicare expenses and are not a driver for Medicare spending. Aggregate inflation-adjusted charges by radiation oncology have dramatically declined in the past 5 years and represent a stable fraction of total Medicare charges. The need to target radiation oncology with cost-cutting measures may be overstated.
2019 年，医疗保险和医疗补助服务中心提出了一种新的放射肿瘤学替代支付模式，旨在降低支出。我们研究了每个专业允许的医师医疗保险费用总额的变化，为拟议的变化提供了当代背景，并假设放射肿瘤学费用在 2017 年保持稳定。
从 2002 年到 2017 年，分析了按医师专业划分的原始 Medicare 受益人的医疗保险医师/供应商利用、计划支付和平衡计费。检查了医师/供应商费用制下的总允许收费、经通胀调整的收费和每个专业收费总额的百分比。我们使用美国劳工统计局的医疗保健消费者价格指数对通胀进行了调整。
总允许收费从 2002 年的 830 亿美元增加到 2017 年的 1380 亿美元。向 Medicare 计费最多的专业是内科和眼科。放射肿瘤学收费分别占 Medicare 2002 年、2012 年和 2017 年允许收费总额的 1.2%、1.6%和 1.4%。2002 年至 2012 年（从 9.876 亿美元增加到 14.2 亿美元），放射肿瘤学收费允许增加了 44%，经通胀调整后，2012 年至 2017 年（从 11.5 亿美元减少到 11.15 亿美元）减少了 19%。2002 年至 2012 年（经通胀调整后，从 85.3 亿美元减少到 83.6 亿美元），内科总允许收费减少了 2%，从 2012 年到 2017 年（经通胀调整后，从 70.5 亿美元减少到 7.05 亿美元）减少了 16%。经通胀调整后，眼科收费从 2002 年到 2012 年增加了 18%（从 4.53 亿美元增加到 5.36 亿美元），从 2012 年到 2017 年增加了 3%（从 5.5 亿美元增加到 5.5 亿美元）。
放射肿瘤学医师收费仅占 Medicare 总支出的一小部分，并不是 Medicare 支出的驱动因素。过去 5 年来，经通胀调整的放射肿瘤学总收费大幅下降，占 Medicare 总收费的稳定比例。通过削减成本措施针对放射肿瘤学的必要性可能被夸大了。
