1014 - Impact of Hypofractionation on RVU Generation in Radiation Oncology

04:00pm - 04:05pm ET

Room 109

Presenter(s)

Sarisha Mahajan, BS - Case Western Reserve School of Medicine, Cleveland, OH

N. G. Zaorsky¹, S. Mahajan², D. E. Spratt³, J. Bird⁴, K. Nieto⁵, M. Wang⁴, and S. R. Keole⁶; ¹Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, ²Case Western Reserve School of Medicine, Cleveland, OH, ³University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, ⁴University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, ⁵Mayo Clinic Radiation Oncology, Jacksonville, FL, ⁶Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ

Purpose/Objective(s):

Radiation oncology has had increased use of hypofractionated radiotherapy schedules (including moderate- and ultra-hypofractionation/SBRT) since the 2000s. The US billing system favors longer fractionation schedules for reimbursement, calculated by relative value units (RVUs). We hypothesized that hypofractionation has led to a significant decline in RVU generation in the US.

Materials/Methods:

We included the 15 most commonly treated cancers in 3 settings (definitive, neoadjuvant, adjuvant) based on published literature about facility volume and fractionation trends from the National Cancer Database (NCDB), at time of initial diagnosis. We calculated RVUs based on Current Procedural Terminology (CPT) codes from various fractionation regimens and the proportion of patients receiving each fractionation at the start vs end of the period (2000s vs 2020s). One sample t-tests were used to compare RVUs pre- vs post-implementation of hypofractionation with 95% CIs.

Results:

There was an estimated total of 46,368 patients treated per year. Two sites that had the greatest intra-site RVU change, and impact on radiation oncology overall: (1) Breast (adjuvant radiation therapy), with 27.7% of all cancer patients, and 99.0% getting conventional fractionation in the 2000s vs 20.0% in the 2020s, corresponding to a relative decrease of 26.4% in RVUs for this disease site (95% CI: 0.733-0.738, P<0.001) and 7.30% change overall in RVUs generated by radiation oncology. (2) Prostate (definitive radiation therapy), with 9.20% of all cancer patients, and 79.0% getting conventional fractionation in the 2000s vs 36.6% in the 2020s, corresponding to a relative decrease of 26.8% in RVUs for this disease site (95% CI: 0.729-0.736, P<0.001), and 4.64% change overall in RVUs generated by radiation oncology. Additionally, decreases in RVUs in the following sites were statistically significant with P<0.001: metastasis / palliative, localized non-small cell lung, primary brain, rectum, bladder, pancreas, and small cell lung. Palliative radiation therapy for metastasis made up the highest portion of patients receiving radiotherapy (36.9% of all patients), but had a smaller impact on overall changes to RVUs, < 1% decrease for radiation oncology. Additional sites that had minimal changes in RVUs generation overall (due to limited use of hypofractionation) were prostate (adjuvant setting), cervix, esophagus, anus, and others. However, based on their low total incidence (26.2% of all patients, 37% [2000s] and 41% [2020s] of RVUs), hypofractionation for these cancers is responsible for a <2% change in RVUs for radiation oncology overall.

Conclusion:

Since the 2000s, hypofractionation has led to a 14.5% decrease in RVUs in radiation oncology. This study highlights the growing disconnect between advancements in radiotherapy and RVU-based reimbursement models, showing the need for change in reimbursement structures to promote the financial stability of modern radiation oncology.