Skip to main content
An official website of the United States government
Grant Details

Grant Number: 5R01CA208758-03 Interpret this number
Primary Investigator: Howard, David
Organization: Emory University
Project Title: Targeted Payment Cuts to Reduce Unproven Care
Fiscal Year: 2019


Project Summary Reducing reimbursement levels within a fee-for-service environment is a promising approach for reducing ineffective and unproven care when revoking coverage entirely or shifting financial risk to providers are infeasible. Intensity-modulated radiation therapy (IMRT) was rapidly adopted into practice as a treatment for breast and prostate cancer patients in the early to mid-2000s despite the absence of high quality evidence demonstrating its superiority to conventional radiotherapy. Based on the rising volume of claims for IMRT and a Wall St. Journal article calling attention to the perverse incentives inherent in physician self-referral for IMRT, the Centers for Medicare & Medicaid Services (CMS) cut the payment rate for IMRT by 15% between 2012 and 2013. Using Medicare claims data, we propose to study the impact of the payment cut on the use of IMRT and medical costs. We will study trends in the use of IMRT across three patient groups that differ in their ability to benefit from IMRT: prostate cancer patients receiving initial treatment, prostate cancer patients receiving radiotherapy following prostatectomy, and breast cancer patients receiving radiotherapy following breast conserving surgery. We will use several strategies to accurately estimate the impact of the payment cut. The magnitude of the cut differed across CMS payment areas. We will determine if declines in the use of IMRT were larger in areas that experienced steeper cuts. Separately, we will compare trends in the use of IMRT in three practice settings that differ in terms of the impact of the cut on practice income: self-referring physician offices, non-self-referring physician offices, and hospital outpatient departments (which were unaffected by the cut).


Medicare fee reductions and the overuse of intensity-modulated radiotherapy.
Authors: Howard D.H. , Hockenberry J. .
Source: Health services research, 2021 Aug; 56(4), p. 626-634.
EPub date: 2021-04-27.
PMID: 33905136
Related Citations

Trends in the use of active surveillance and treatments in Medicare beneficiaries diagnosed with localized prostate cancer.
Authors: Liu Y. , Hall I.J. , Filson C. , Howard D.H. .
Source: Urologic oncology, 2021 Jul; 39(7), p. 432.e1-432.e10.
EPub date: 2020-12-09.
PMID: 33308973
Related Citations

Intensity-Modulated Radiation Therapy in Breast Cancer Patients Following the Release of a Choosing Wisely Recommendation.
Authors: Torres M.A. , Gogineni K. , Howard D.H. .
Source: Journal of the National Cancer Institute, 2020-03-01; 112(3), p. 314-317.
PMID: 31647560
Related Citations

Back to Top