On the Role of Technology in Radiation Oncology

Kelly Orwat, M.D., is a board-certified radiation oncologist and serves as associate director of Radiation Oncology at Mercy. Dr. Orwat recently responded to questions from MDLinx.com—a specialized, curated news and information platform for physicians, healthcare professionals (HCPs), and patients—regarding hypofractionation, intensity-modulated radiation therapy (IMRT) reimbursement changes, and AI-driven automation. Here are her responses:

The Centers for Medicare and Medicaid Services (CMS) introduced IMRT reimbursement changes, which were particularly drastic for 2026; these reimbursement cuts, combined with increasing use of hypofractionation, strain practice operating budgets at a time where costs to provide high-quality care have continued to increase.  

Radiation oncology clinics require not only a costly treatment machine but also a service contract, a CT [scan] for treatment planning, computer software licenses, multiple specialized pieces of equipment for the treatment of individual sites, in addition to staffing.  

In 2026, Medicare introduced multiple cuts in reimbursement, including a new efficiency adjustment. [This] eliminated many radiation oncology billing codes, including those for daily image guidance utilized by radiation therapists and reviewed daily by the physician to ensure accuracy of radiation delivery; [it also] eliminate[ed] the IMRT codes, consolidating them into complexity-based codes more. A related but separate challenge both doctors and patients struggle with is the large number of insurance denials and prior authorizations, which delay patient care and require the use of further already strained resources.

Currently, AI has not caused a significant change in my clinic, but I anticipate it will, particularly for our dosimetrist. The auto-contouring does a reasonably good job outlining most normal organs requiring minimal adjustments. Based on my experience, I do not consider it reliable for outlining treatment volumes. With continued improvement, it may decrease the workload for our dosimetrist, potentially requiring a clinic to employ a lower number to care for their volume of patients.  

Another change [that] could impact both workforce and the clinic environment is the allowance for physicians to supervise the office by being virtually available, rather than physically present while patients are treated. This could potentially decrease the need to hire locums or fill-in doctors for vacation coverage at the expense of having a doctor available in the clinic.

Practice consolidation does continue to occur, with private radiation oncology practices being less common. A private radiation oncology practice that was in the Baltimore region until last year was employed by a hospital system in the fall of 2025. The reasons that private practices are becoming less common include the more challenging financial environment where it is difficult to absorb the higher operating costs along with the decreasing rates of reimbursement, in addition to the desire of many large hospital systems to employ the physicians rather than contract with private practitioners.  

– Dr. Kelly Orwat, M.D. 

Utilizing the latest radiation oncology technologies, Dr. Kelly Orwat is skilled in advanced radiation therapy techniques, including the cutting-edge CyberKnife system and state-of-the-art linear accelerators, enhancing treatment efficacy and patient outcomes. With a distinct focus on central nervous system cancers, Dr. Orwat is passionate about pioneering innovative methods to reduce immediate discomfort and long-term side effects, ensuring the most advanced and patient-friendly cancer care available.