Nearly one-fourth of practices say operating costs are up since prior to the pandemic, with professional staffing expenses the main driver, according to survey data released Tuesday.

About 93% physicians surveyed said their business is grappling with key shortages among clinical staff, including nurses and physicists, and 80% believe such challenges are worse than in 2022. The findings are part of an American Society for Radiation Oncology survey of the specialty, released to coincide with the association’s Advocacy Day.

ASTRO is highlighting the data as it presses Congress to address flagging reimbursement rates that are failing to keep pace with inflation.

“A decade of relentless Medicare cuts and rapidly increasing costs are pushing community-based clinics to the breaking point,” Geraldine M. Jacobson, MD, MBA, chair of the society’s board of directors, said in a May 23 statement. “Radiation oncologists are asking lawmakers to support our fight against any new cuts, and to join us in our efforts to ensure stability, access, value and equity in cancer care.”

The society conducted the survey of its members between March and April, reaching a total of nearly 250 radiation oncologists. About 53% of respondents said staffing shortages are causing treatment delays, while 44% believe they’re fostering anxiety among patients. Another 77% think clinical staffing is what’s driving up costs at their practice. And 48% of those surveyed said they’re cutting ancillary services such as patient navigation to counter surging expenses.

Radiation oncology is among those facing the highest cuts across medical specialties, with Medicare reimbursement sliding 20% during the past 10 years, ASTRO estimated. This includes declining payment for all 16 of the most common radiation therapy courses in the decade leading up to 2020, according to a recent study.

Along with Medicare reform, ASTRO wants lawmakers to address prior authorization. Another 2021 study found that radiation oncology faces the heaviest burden from this utilization-management tactic used by payers, ahead of diagnostic radiology and cardiology. About 90% of practice leaders said patients have been forced to wait for treatment because of these roadblocks. The majority of respondents said delays have lasted a week or longer.

The society praised CMS for a recent final rule aimed at curtailing prior authorization tactics used by Medicare Advantage plans. However, ASTRO wants Congress to now “hold insurers accountable for following these new requirements.”

“Prior authorization for proven treatments ultimately causes more harm than good by squandering valuable time and resources, which negatively impacts patient outcomes,” Jacobson said in the statement.