Purpose: Radiation and medical oncology face pressure from payment changes, which aim to increase the value of care and curb rising spending. Multiple models have been proposed or implemented, with mixed results for cost saving and financial stability. While previous studies have quantified changes in Medicare reimbursement for radiation oncology on a per-code basis, this has not been done in medical oncology to our knowledge, and no direct comparisons have been made between oncology subspecialties at this level. Our study aims to quantify and analyze Medicare reimbursement changes for medical and radiation oncology billing codes.

Materials/methods: In this longitudinal study of reimbursement, the publicly available Physician/Supplier Procedure Summary database was used to obtain Medicare reimbursement data for 2010, 2016, and 2020. All reimbursement for providers with primary provider codes 92 (radiation oncology), 83 (hematology oncology), and 90 (medical oncology) were analyzed, combining hematology and medical oncology. Inflation- and utilization-adjusted changes in reimbursement were calculated from 2010-2020 and 2016-2020 on a per-code basis with results grouped by specialty and billing category.

Results: From 2010-2020, inflation- and utilization-adjusted Medicare reimbursement decreased by $1.2B (-16%) for all codes, $705M (-29%) for radiation oncology-specific codes, and $541M (-10%) for medical oncology-specific codes. From 2016-2020, inflation- and utilization-adjusted reimbursement decreased by $299M (-3%) for all codes, $108M (-5.6%) for radiation oncology-specific codes, and $191M (-2.2%) for medical oncology-specific codes. Chemotherapy (-40%) and radiotherapy (-33%) saw the largest decreases in inflation- and utilization-adjusted reimbursement from 2010-2020, while immunotherapy (+21%) saw the largest increase.

Conclusions: Our analysis shows continually decreasing Medicare reimbursement for both radiation and medical oncology from 2010-2020 and 2016-2020. This decade-long continuous decline highlights the need for payment system stabilization-whether through episode-based payment models or another avenue.

Copyright © 2025. Published by Elsevier Inc.

目的： 放射治疗和肿瘤学面临着由于支付方式的变化而带来的压力，这些变化旨在增加医疗服务的价值并遏制不断上涨的支出。已经提出了多种模式并付诸实施，但成本节约和财务稳定的效果参差不齐。虽然之前的研究量化了医疗保险对放射治疗的报销变动情况，但我们知道在医学肿瘤领域还没有类似研究，并且没有直接对比不同肿瘤学亚专科的数据。本研究旨在量化和分析医疗保险对于医学和放射治疗肿瘤科编码的支付变化。

材料/方法： 在这项关于报销的纵向研究中，我们使用了公开可获取的Physician/Supplier Procedure Summary数据库，获得了2010年、2016年和2020年的医疗保险报销数据。分析了所有具有主要提供者代码92（放射治疗肿瘤科）、83（血液学肿瘤科）和90（医学肿瘤科）的提供商的报销情况，并将血液学与医学肿瘤科合并在一起进行分析。从2010年到2020年以及从2016年到2020年的通胀率和使用量调整后的每项代码的报销变化被计算出来，结果按专业领域和账单类别分组。

结果： 从2010年至2020年间，经过通胀率和使用量调整后的医疗保险总支付减少了12亿美元（-16%），放射治疗肿瘤科特定代码的支付减少了7.05亿美元（-29%），医学肿瘤学特定代码的支付减少了5.41亿美元（-10%）。从2016年到2020年间，经过通胀率和使用量调整后的总支付减少了2.99亿美元（-3%），放射治疗肿瘤科特定代码的支付减少了1.08亿美元（-5.6%），医学肿瘤学特定代码的支付减少了1.91亿美元（-2.2%）。从2010年至2020年间，化疗和放疗的通胀率和使用量调整后的报销分别下降了40%和33%，而免疫治疗则增长了21%。

结论： 我们的分析显示，在2010年到2020年以及从2016年到2020年间，医疗保险对放射治疗和医学肿瘤科的支付持续下降。这种长达十年的连续下降突显了需要通过基于事件的支付模式或其他方式来稳定支付系统。