Purpose/Objective(s): The Physician and Other Supplier Public Use File (POSPUF) records information on services and procedures provided to Medicare beneficiaries and covers calendar years 2012 through 2015. This dataset offers a unique opportunity to explore trends and variability in the use of high cost medical resources. Here, we examine the utilization over time of the following services provided by radiation oncologists in the United States: Stereotactic body radiation therapy (SBRT)/stereotactic radiosurgery (SRS), brachytherapy, proton therapy, consults, and complex simulations.

Materials/Methods: The POSPUF dataset was queried for Medicare Part B non-institutional claims submitted by US radiation oncology providers from calendar years 2012 through 2015. For each service submitted for reimbursement, the Healthcare Common Procedure Coding System (HCPCS) code, description of service, as well as the year of service was extracted. HCPCS descriptions were used to categorize each reimbursed service appropriately. A negative binomial model treated the variable year as an independent variable to assess for any changes over time with respect to the types of services Medicare reimbursed. The results are reported as an odds ratio (OR) with 95% confidence intervals (CI) with respective p-values (statistical significance set at p<.05). All analyses were performed with statistical software (R Foundation for Statistical Computing, Vienna, Austria).

Results: In total, 259,838 claims were included in the analysis: 69,435 in 2012; 69,217 in 2013; 60,808 in 2014; and 60,377 in 2015. Over time, there was an increase in the utilization of SRS/SBRT (OR 1.11; 95% CI: 1.07-1.14, p<0.00001) and proton therapy (OR 1.26; 1.11-1.42, p<0.0003). No significant changes over time were seen in the use of brachytherapy (OR 0.97; 95% CI 0.91-1.02, p=0.23), consults (OR 1.00; 95% CI 0.99-1.01, p=0.66) or complex simulations (OR 0.1.01; 95% CI 0.99-1.02, p=0.28). Table 1 displays each service submitted for reimbursement as a percentage of the total submitted reimbursements by year.

Conclusion: Emerging technologies are changing reimbursement patterns for radiation oncologists an increase in the use of proton and stereotactic treatments over time. The number of consultations, brachytherapy treatments and complex simulations reimbursed by Medicare did not change over the time period examined. Future research should examine any changes in reimbursement for these services.

SRS/SBRT Year Percent of total claims 2012 1.08% 2013 1.16% 2014 1.33% 2015 1.45%

Brachytherapy Year Percent of total claims 2012 0.37% 2013 0.38% 2014 0.32% 2015 0.34%

Proton therapy Year Percent of total claims 2012 0.05% 2013 0.08% 2014 0.09% 2015 0.10%

Consults Year Percent of total claims 2012 10.02% 2013 10.09% 2014 9.96% 2015 9.98%

Complex Simulations Year Percent of total claims 2012 5.40% 2013 5.40% 2014 5.50% 2015 5.50%