Medicare spending $10M less each year on radiation therapy, due to recent practice change
Medicare is spending approximately $10 million less each year on radiation therapy, thanks to a recent practice shift amid the COVID-19 pandemic.
The 2020 public health crisis prompted a greater emphasis around shorter-course radiation therapy for women with early stage breast cancer. Experts note that this change was motivated by an urgent need to reduce patient exposure to the virus and minimize the number of healthcare visits.
However, the practice change also produced the added benefit of drastically reducing costs for the Medicare program and its beneficiaries. Neiman Health Policy Institute researchers also highlight that this success underlines providers’ ability to quickly move to new treatment paradigms, when properly motivated.
"These findings demonstrate the potential for healthcare systems to more rapidly adopt high-value care when evidence, professional guidance and clinical necessity align," senior study author Elizabeth Rula, PhD, executive director of American College of Radiology-backed institute, said in a statement Sept. 10. "Importantly, the shift toward shorter treatment regimens reduced burden on patients while also generating measurable savings for the Medicare program."
To back their claims, Rula and colleagues analyzed a nationally representative, 5% sample of Medicare fee-for-service claims for women diagnosed with breast cancer between 2018 and 2021. Investigators found that use of ultra-hypofractionated radiotherapy—which delivers larger daily doses of radiation over five or fewer sessions—increased from 2% before the pandemic up to over 8% afterward. Meanwhile, the delivery of conventional radiation schedules, requiring 22 or more treatments, dipped from 23% down to 16%.
Altogether, the study sample included nearly 4,100 Medicare beneficiaries newly diagnosed with early stage breast cancer, and treated with lumpectomy and post-surgery radiation therapy. Experts believe this transition is notable, given that adoption of previous evidence-based breast radiation regimens occurred gradually “over many years,” despite strong clinical evidence. In contrast, use of this shorter-course, five-fraction approach increased rapidly following the publication of key clinical trial data and pandemic-era guidance.
"The pandemic created an urgent need to reduce patient exposure risk and minimize healthcare visits, but this study shows that this need translated to beneficial clinical changes," added co-lead author Andre A. Konski, MD, MBA, a professor of radiation oncology with the University of Pennsylvania, Philadelphia. "In the face of such pressure, and with clinical evidence supporting a more convenient and equally effective treatment approach, practice patterns can change much more rapidly than many would expect."
Neiman experts note that the change in radiation treatment patterns lowered average radiotherapy spending by about $412 per patient. Across all treatment regimens studied, average radiotherapy costs ranged from about $1,848 for the shorter-course, ultra-hypofractionated approach to $8,820 for conventional, longer-course schedules. This highlights the “substantial economic implications of expanding use of evidence-based shorter course therapy,” experts contend.
When extrapolating these results to an estimated 24,000 patients treated per year, Medicare is conservatively saving about $10 million annually, Rula told Radiology Business.
“While we studied this in Medicare because it was the best available dataset for the detail required for the study, the savings would be much higher in a commercially insured population,” she said by email. “From a patient perspective, the shift to shorter treatment schedules reduces both the direct burden of the treatment as well as their out-of-pocket costs.”
The analysis also identified regional differences in adoption of shorter-course radiotherapy. For instance, patients residing in the Northeast experienced the greatest increase in ultra-hypofractionated RT amid the pandemic. However, similar increases were not observed among black patients, “suggesting opportunities for future research on equitable access to emerging treatment approaches.”
The results were published Sept. 9 in the American Journal of Clinical Oncology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.