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Trends in Medicare utilization and reimbursement for hematology/oncology procedures from 2012 to 2023: A geriatric

J Conic1, T Reske2

  • 1Department of Internal Medicine, Section of Geriatric Medicine Louisiana State University Health Sciences Center New Orleans Louisiana USA.

Aging Medicine (Milton (N.S.W))
|May 10, 2024
PubMed

Insights

Medicare reimbursement for hematology/oncology procedures significantly declined between 2012 and 2023. This trend, adjusted for inflation, saw substantial decreases in compensation for common procedures.

Area of Science:

  • Health Economics
  • Oncology
  • Hematology

Background:

  • Limited data exists on reimbursement trends in hematology/oncology.
  • Understanding these trends is crucial for practice sustainability and patient care.

Purpose of the Study:

  • To analyze reimbursement trends for common hematology/oncology procedures from 2012 to 2023.
  • To provide data-driven insights into the financial landscape of cancer care.

Main Methods:

  • Utilized the Centers for Medicare and Medicaid Services' Physician Fee Schedule Look-Up Tool.
  • Collected reimbursement data for 40 hematology/oncology procedure codes (2012-2023).
  • Adjusted data to 2023 US dollars using the Consumer Price Index (CPI).

Main Results:

  • Gross facility price reimbursement decreased by 4.4%; non-facility price increased by 9.2%.
  • Inflation-adjusted compensation decreased by 96.1% (facility) and 96.6% (non-facility).
  • No examined Current Procedural Terminology (CPT) codes showed an increase in net reimbursement.

Conclusions:

  • Medicare reimbursement for key hematology/oncology procedures has decreased significantly from 2012 to 2023.
  • These findings highlight potential financial challenges for oncology practices.
  • Further research is needed to assess the impact on patient care delivery.
Abstract

Keywords:
Medicaregeriatrichealth systemshematologyoncologyphysician reimbursement

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