title: Quantitative evaluation of radiation oncologists' adaptability to lower reimbursing treatment programs.
abstract: OBJECTIVE
  Rapid development of sophisticated modalities has challenged radiation oncologists to evaluate workflow and care delivery processes. Our study assesses treatment modality use and willingness to alter management with anticipated limitations in reimbursement and resources.
  
  
  METHODS
  A web-based survey was sent to 43 radiation oncologists in a National Cancer Institute-designated comprehensive cancer center network. The survey contained 7 clinical cases with various acceptable treatment options based on our institutional clinical pathways. Each case was presented in 3 modules with varying situations: (1) unlimited resources with current reimbursement, (2) restricted reimbursement (bundled payment), and (3) both restricted reimbursement and resources. Reimbursement rates were based on the 2013 Medicare fee schedule. Adoption of lower reimbursing options (LROs) was defined as the percentage of scenarios in which a respondent selected an LRO compared with baseline.
  
  
  RESULTS
  Forty-three physicians completed the survey, 11 (26%) at academic and 32 (74%) at community facilities. When bundled payment was imposed (module 1 vs 2), an increase in willingness to adopt LROs was observed (median 11.1%). When physicians were limited to both bundled payment and resource restriction, adoption of LROs was more pronounced (module 1 vs 3; median 22.2%, P < .01). There was a trend to selecting LROs between module 1 and 2 that reached significance when transitioning from module 1 to 3. A positive correlation between years in clinical practice and adoption of LROs was demonstrated (r(2) = 0.181, P<.01). This association remained significant when stratifying respondents by experience (≤25 vs >25 years, P = .02).
  
  
  CONCLUSIONS
  Radiation oncologists were more likely to choose lower reimbursing treatment options when both resource restriction and bundled payment were presented. Those with fewer years of clinical practice were less inclined to alter management, perhaps reflecting modern residency training. Future cost-utility analyses may help to better guide radiation oncologists in selection of LROs.
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Beant S
authors.initials: BS
authors.lastname: Gill
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Malolan S
authors.initials: MS
authors.lastname: Rajagopalan
authors.affiliation: Department of Biostatistics, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Hodges
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania. Electronic address: greenbergerjs@upmc.edu.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Greenberger
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D010414:Pennsylvania; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data*; D018787:Radiation Oncology / Q000191:economics*; D012051:Reimbursement Mechanisms; D011795:Surveys and Questionnaires