MO-D-213AB-01: A Brief History of Medical Physics Reimbursement

"Corporate memory" is important in many areas of medical physics, but especially so in the area of economics. To appreciate where medical physics currently resides in the reimbursement arena, it is imperative that we know from whence we came. This talk will trace the history of medical physics reimbursement, chiefly in the area of radiation oncology since most of our reimbursement codes appear in that clinical specialty. We will begin with the initiation of the Harvard RBRVS system and the effect it had on our field. Subsequently, we will trace the impact of new technological advances in the field and how, at each juncture, the reimbursement associated with these advances directly impacted our employment opportunities and salaries. Although much of the operations of the three chief panels associated with health care reimbursement, the Current Procedural Terminology (CPT) Editorial Panel, the Relative-Value Update Committee (RUC) and the Centers for Medicare and Medicaid Services (CMS) are confidential in nature, the history of how these panels operate and their impact on how health care is reimbursed is important to our field. For those of us who have labored in this arena over the years, there are successes and failures as new procedures in radiation oncology were taken for reimbursement consideration, initially by the Joint Economics Committee of ACR and ASTRO, and later by ASTRO in collaboration with AAPM. These will be discussed in a general sense to avoid confidentiality breaches. As we progressed from the use of CT planning images with 3D conventional therapy, brachytherapy -high and low dose rate systems, IMRT planning and delivery (with concomitant plan verification work) to the latest procedures of SRS and SBRT with Image Guided Radiation Therapy (IGRT), each procedure has its own story surrounding how its reimbursement was developed. Where no confidentiality issues are involved, the stories behind the scenes will be discussed as these procedures were taken forward in the reimbursement process. Going forward, changes in how we are reimbursed for our services will inevitably occur. For our imaging colleagues, their work will still be classed as a cost center for their departments. AAPM PEC is evaluating how they can begin being reimbursed with explicit CPT codes, but this will take some effort.

1. Understand where medical physics reimbursement came from in radiation oncology 2. Understand the arrangement of our societies and interaction with reimbursement entities 3. Understand how medical physics workforce and remuneration for services is structured 4. Understand what the future may bring in medical physics reimbursement.