Radiation Treatment Costs Vary Among Medicare Enrollees – Finds Study

Radiation Treatment Costs Vary Among Medicare Enrollees – Finds Study

A new study found that the cost of radiation therapy among Medicare patients varied greatly due to factors unrelated to a patient or that person's cancer.

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Cancer is the second most common cause of death for men and women in the United States. Reports from the American Cancer Society suggest that there will be as many as 1,658,370 new cancer cases in the United States in 2015. Oncology specialists play a crucial role in educating people about the debilitating effects of this disease and creating more awareness about the various treatment methods available.

Radiation therapy is one of the most common treatments for cancer. This therapy is used as a primary treatment to destroy the cancer cells or to stop the growth of cancer cells. A radiation oncologist performs this treatment by using targeted and high-energy particles or waves such as X-rays, gamma rays, electron beams and other radioactive substances to destroy or damage cancer cells and tumors and alleviate certain symptoms related to cancer. Radiation can be given alone or used before or after other treatments such as surgery or chemotherapy to shrink a tumor or prevent the growth of any remaining cancer cells. In addition, it can further help relieve symptoms of advanced cancer. Intensity modulated radiation therapy (IMRT), external beam radiation therapy (EBRT), brachytherapy and radionuclide therapy are the different types of radiotherapy treatment. Oncologists administering various treatments should have adequate knowledge about the best practices for radiation oncology medical billing and coding and the latest coding updates. This will help them report accurate diagnostic and procedural codes on the medical claims.

For instance, the following CPT codes are used for intensity modulated radiation treatment delivery (IMRT) 

77385: Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple

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77386: Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex

A new study published in the Journal of Oncology Practice (August 11, 2015 online issue) found significant inconsistency in the cost of radiation therapy among Medicare enrollees. The study

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led by researchers at the Moores Cancer Center at the University of San Diego found that the cost of radiotherapy among Medicare patients varied most widely due to factors unrelated to a patient or that person’s type of cancer.

As part of the study, researchers examined Medicare reimbursement amounts from the SEER database for radiation therapy provided to more than 55, 288 breast, lung or prostate cancer patients diagnosed between the years 2004-2009. Researchers also examined the extent to which the tumor type, radiation therapy provider, or the patient influenced the cost of treatment. The key findings of the study include 

It was found that about 44 to 61 percent of the cost variation for patients depends on the year of diagnosis, clinic type, location of treatment and individual radiation provider.

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Factors associated with the patient or patient’s tumor accounted for less than 3 percent of the variation in the cost of treatment.

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Researchers identified that significant variability in Medicare reimbursement for radiotherapy does not depend on individual characteristics of patients or their cancers.

On the other hand, it was directly related to the provider, geography and technology used to treat patients.

The study results indicate the inefficiencies within the current Medicare reimbursement framework for radiation therapy. In most cases, about two-thirds of patients with cancer receive radiation therapy as part of their treatment. As part of the study, researchers focused more on breast, lung and prostate cancers as they represent the most common malignancies treated with this technique.

The cost of radiation therapy was estimated from Medicare reimbursements for outpatient radiation treatment. The total cost for the treatment for the patients included in the study was estimated to be more than $831 million.

Researchers argue that analyzing the cost variability for radiation therapy will help policy makers evaluate the efficiency of the current fee-for-service Medicare reimbursement system.

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