A detailed review of Medicare claims data from 2016-2022 offers a clear explanation for declining reimbursements in radiation oncology. While relative value units (RVU) have largely remained stable across services, two things have not: the number of RVUs generated per treatment course and the inflation-adjusted dollars received per RVU. The combined effect of these on realized reimbursement is no bueno. Increasing use of hypofractionation for the bread and butter diseases resulted in whopping declines in technical reimbursement of 17% (free-standing) and 15% (hospital outpatient) for breast cancer and 14% (free-standing) and 17% (hospital outpatient) for prostate cancer. Likewise, professional reimbursement took hits of 11% for breast and 12% for prostate. Compound that by declines in inflation-adjusted conversion factors (i.e. dollars per RVU) of 21% in free-standing centers and 12% in hospital outpatient centers. Cue consolidative medicine. | Patel, CURiE 2025
