From 2003 to 2009, radiation oncology exceeded its sustainable growth rate target by nearly 300% . Between 2010 and 2011, the intensity modulated radiation therapy (IMRT) code exhibited the fourth highest percent increase of all Medicare codes . It is difficult to determine the extent to which this spending growth has produced commensurate clinical benefit, but the current payment system raises concerns about overutilization. Hospitals and clinics are reimbursed for each discrete element of care, and the technological focus of radiation oncology generates an abundance of billable units. Adding a radiation beam, using IMRT, or spreading the dose out over more treatments all generate additional revenue. Fee-for-service payment creates widespread inefficiency as payers spend large sums to create and enforce guidelines, and providers devote substantial resources to ensure appropriate billing.
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