1017 - Trends and Variation in Spending for Radiation Treatment Episodes for Medicare Patients with Cancer

Monday, September 30, 2024

3:25 PM – 3:30 PM ET

Location: Room 143

Presenter(s)

Miranda Lam, MD, MBA

Brigham and Women's Hospital/Dana-Farber
Boston, MA, United States

M. Lam¹, M. B. Landrum², B. Buzzee², B. Landon^2,3, and N. L. Keating^2,4; ¹Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, ²Department of Health Care Policy, Harvard Medical School, Boston, MA, ³Beth Israel Deaconess Medical Center, Boston, MA, ⁴Brigham and Womens Hospital, Boston, MA

Purpose/Objective(s): Spending on care for cancer patients can be substantial and has continued to increase in recent years. Radiation treatments (RT) are a vital component of cancer care, and as alternative payment models are being employed and more advanced RT modalities are utilized, more information is needed regarding variation in RT spending. We aimed to describe trends in RT spending over time and identify potential drivers of practice-level variation in spending.
Materials/

Methods: Using 2009-2020 national Medicare claims, we identified patients with cancer enrolled in fee-for-service Medicare undergoing RT and examined RT-specific spending during the 90 days following RT initiation. The unit of analysis was a 90-day RT episode triggered by RT initiation. In unadjusted analyses, we summed RT-specific episode standardized spending by cancer type over time. RT episodes were categorized by type of technology (2D/3D conventional, intensity-modulated, stereotactic, proton, brachytherapy) based on the majority of fractions within the 90-day episode. We characterized variation in practice-level RT-specific spending and assessed the extent to which variation was explained by patient demographic and clinical factors and geographic region. We estimated linear regression models that included random effects for each practice to understand practice-level variation in standardized RT-specific spending and sequentially added variables to control for year, patient demographic and clinical characteristics (sex, race and ethnicity, Medicaid eligibility, cancer type, and patient risk based on Hierarchical Condition Categories), and hospital referral region.

Results:

From 2009-2020, 1,898,864 beneficiaries with cancer initiated 2,149,385 90-day RT episodes at 2,150 practices. Mean (standard deviation) RT-specific spending for a 90-day episode was $13,683 ($8,628). RT-specific per-episode spending increased over time ($12,978 in 2009 to $13,689 in 2020), while the median number of fractions per episode decreased (25 in 2009, 16 in 2020). The proportion of RT episodes of intensity-modulated RT, stereotactic RT, and proton RT increased, while use of 2D/3D conventional RT decreased. Use of brachytherapy remained stable. Practice-level per-episode spending variation (standard deviation $2,882) remained high even after adjusting for patient demographic and clinical characteristics and geographic region.
Conclusion: 90-day RT per-episode spending has increased over time. We identified substantial variation in practice-level RT per-episode spending for cancer patients that is not strongly driven by patient characteristics or geographic region. Further investigations are needed to elucidate practice-level factors associated with spending, as alternative payment models in oncology care typically are implemented at the practice level.