Impact of Maintenance of Certification in Radiation Oncology on Utilization and Medicare Costs

This study aims to test the hypothesis that participation in American Board of Radiology (ABR) maintenance of certification (MOC) among radiation oncologists is associated with greater utilization of contemporary radiation therapy techniques, shorter treatment courses, and differences in Medicare spending.

A retrospective analysis of the 2022 Centers for Medicare & Medicaid Services (CMS) Medicare Part B Public Use File was conducted. Radiation oncologist data was extracted and linked to ABR certification and MOC. Healthcare Common Procedure Coding System (HCPCS) codes were analyzed to determine technique-specific utilization rates and Medicare costs by MOC. Average treatment course length was approximated using a treatment duration index (TDI) derived from professional treatment-management billing codes; TDI was used as a practice-level surrogate and not a direct measure of delivered fractions.

Nearly all (98.7%) time-limited ABR radiation oncology diplomates identified participated in MOC, whereas 9.3% of lifetime certificate holders voluntarily participated. MOC participants more frequently used advanced radiation techniques including intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy. Mean TDI was lower for MOC participants vs nonparticipants (2.9 vs 3.3). Multivariable analysis demonstrated non-significant lower Medicare professional costs per physician for MOC participants ($107,000 vs $113,000), and significantly lower (-10.31%) Medicare costs per radiation treatment course.

Voluntary MOC participation among lifetime ABR-certified radiation oncologists is low. MOC participating radiation oncologists demonstrate greater adoption of advanced techniques and shorter treatment courses, and lower treatment-level spending intensity, whereas differences in total physician-level Medicare spending were modest and not statistically significant. MOC participation may be an indicator of practice-pattern differences in radiation oncology.