Raw Medicare data singles out radiation oncology. That’s misleading.

This past April, just after the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated 2012 Medicare provider charge data, the New York Times published an article,”Sliver of Medicare Doctors Get Big Share of Payout.”

Almost everyone agrees that transparency in the Medicare payment system will likely lead to more efficient health care delivery with less waste and less fraud. However, thoughtful analysis must be performed so that undue stigmatization will not occur.

The field of radiation oncology was singled out in the article with, “fewer than 1,000 radiation oncologists, for example, received payments totaling $1.1 billion.”  While this may be a true statement, it is somewhat misleading.

Radiation oncology is the field of medicine that utilizes ionizing radiation to treat cancers, which almost always in involves highly sophisticated linear accelerators or difficult-to-produce radioisotopes.  New linear accelerators cost upwards of 4-6 million dollars, not to mention the dedicated infrastructure and the annual maintenance contracts, which may be in the hundreds of thousands of dollars.

Medicare has intended to offset this high cost of ownership through the technical reimbursement for particular procedures. In most cases, the technical reimbursement is billed by the hospital, corporation, or practice partnership that owns the equipment. In the current environment, the minority of radiation oncologists has ownership stake.

In a more detailed analysis for radiation oncology, we have calculated from the Medicare physician payment data for 2012 that approximately 1,500 out of over 4,000 radiation oncologists bill for this technical component, with an average total Medicare reimbursement of approximately $780,000. For those who do not bill the technical component, the average is approximately $116,000.

Given that much of those reimbursements go toward defraying the cost of equipment ownership, one must be careful not to conclude that the aforementioned $1.1 billion was going towards lining the pockets of those 1,000 radiation oncologists.  There are many fields that utilize this technical component of reimbursement; radiation oncology is only one example.

Great care must be taken not to jump to conclusions when looking at the raw data that Medicare released. Given that many media outlets are reporting different facets of “big” public healthcare data in different ways, we as physicians and providers must set the record straight. Indeed, the American Medical Association and other professional societies (for example the American Academy of Orthopaedic Surgeons  and the American Physical Therapy Association) have commented on the difficulty in interpretation of the raw data without informed knowledge and context. Hopefully, as more researchers, analysts, and journalist look through the data with a sharper lens, the public will be given the context it needs to understand these highly nuanced issues.

Sea Chen is a radiation oncologist.

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