Trends in Fractionation in Radiation Oncology Over the Past Decade.

Abstract

PURPOSE/OBJECTIVE(S)\nAdvances in radiation oncology have allowed for more accurate targeting of treatment areas allowing for safer hypofractionation. Additionally, many trials have been published supporting the use of hypofractionation as an alternative to longer courses of radiation. In the United States most reimbursement models are currently based on a fee for service model which increases payment based on the number of treatments delivered. Our goal was to analyze available Medicare billing data in order to evaluate trends in fractionation in the United States.\n\n\nMATERIALS/METHODS\nMedicare Provider Utilization and Payment Data was accessed from the CMS.gov website for years 2012 - 2018. Radiation Oncology specific providers (ROP) and only data corresponding to the billing code for status checks (77427), were extracted. Status checks (SC) were used as a surrogate for length of fractionation. Only ROP s that were practicing every year between 2012 through 2018 were included and those with less than 100 status checks in a year at any single practice setting were excluded. Providers were classified as hospital-based practices versus independent clinics and academic versus private practice. ROP s were separated into four regions based on Census classifications: Northeast, Midwest, South, and West.\n\n\nRESULTS\nAmongst ROP s with at least 100 SC per year, there was an overall decrease in average number of SC per patient from 2012 to 2018 (3.96 to 3.64, respectively) or an overall 8% decrease in fractions delivered per patient. This holds true for those based in hospitals (3.85 to 3.45) and independent clinic (4.07 to 3.73) locations from 2012 to 2018, respectively. The number of patients per year each provider treated has decreased from 172 (2012) to 163 (2018). The total number of providers seeing at least 100 SC/year has decreased from 2012 to 2018 (2,353 to 2,011). A decrease in fractionation was experienced in all regions of the country with the largest overall decrease in the Northeast (13% vs 8.8% in the South). Large practices (greater than 10 ROP s) treated less fractions per patient than smaller practices. A larger decrease in fractions per patient was seen in academic practices with a 14% drop in status checks per patient vs 9.9% in private practices from 2012-2018. In 2018, academic physicians treated each patient with 15% less fractions than private practice.\n\n\nCONCLUSION\nTrends in fractionation confirm that as a specialty, we are moving more towards hypofractionation with an overall decrease in fractions per patient over the past decade. This is seen in all settings regardless of practice setting, location, and size of practice. Academic ROP s have decreased the rate of fractions per patient at a slightly higher rate than private practice ROP s. Given the reduced number of visits for the patient, this is a positive for improving the cost-effectiveness of medicine as well as reducing the financial and logistical burden for the patient.