There is considerable data showing that disparities in payment across sites of service increase costs to patients, insurers and taxpayers as well as result in marketplace consolidation that limits patient choice by reducing access to care in the community-setting.
To control costs and reward efficiency, Medicare pays the majority of hospitals under PPSs, which make payments on the basis of the clinical classification of each service. In response to concerns that cancer hospitals would experience payment reductions under a PPS, beginning in 1983, Congress required the establishment of criteria under which 11 PCHs are […]
Average hospital outpatient department prices for common imaging, colonoscopy and laboratory services can be double the price for identical services provided in a physician’s office or other community-based setting, according to a study by researchers at the former Center for Studying Health System Change (HSC). Using private insurance claims data for about 590,000 active and […]
Two independent trends, acting in combination, are currently resulting in increased Medicare fee-for-service (FFS) chemotherapy payments. The first trend is a shift in the site of care for cancer patients from physicians’ offices to hospital outpatient departments. Several factors contribute to this shift; this study evaluates the effects of one of those factors —the acquisition […]
Cancer remains a top priority for health systems around the world as incidence levels rise, fueled by growing and aging populations. While some incidence is preventable and early diagnosis and treatment can reduce or delay mortality significantly the reality is that countries struggle to bring together the right combination of measures including vaccines, diagnostics and […]
The Physician-based Oncology Practice Acquisition study has three objectives: – Understand historical trends in physician-based oncology practice acquisitions by entities participating in the 340B program (“Covered Entities”) – Measure impact of such acquisitions on 340B chargebacks – Compare timing of such acquisitions with the registration date on the OPA database as a sub-entity of the […]
In a prior memorandum, we presented evidence documenting the growing share of Medicare oncology volume being billed in the outpatient hospital setting, in comparison to the physician office setting. In this report, we present our assessment of the cost consequences to the Medicare program of patients receiving chemotherapy services in physician offices versus hospital outpatient […]
Medicare’s payment rates often vary for the same ambulatory services provided to similar patients in different settings, such as physicians’ offices or hospital outpatient departments (OPDs). For example, in 2013, Medicare pays 141 percent more for a level II echocardiogram in an OPD than in a freestanding physician’s office. These variations raise questions about how […]
The Moran Company was asked by The US Oncology Network, Community Oncology Alliance, and ION Solutions to conduct a series of analyses regarding the hypothesis that there has been a shift in the site of service for chemotherapy services in Medicare from the physician office to the Hospital Outpatient Department (HOPD). This memo provides detailed […]
Avalere Health analyzed three years of commercial health plan data to examine the differences in the total cost of care for cancer patients based on the site of service of chemotherapy or radiation therapy. Our study compared the average total episode costs for patients receiving treatment for cancer in a physician’s office (including freestanding radiation […]
National spending on cancer care in 2010 is estimated at $125 billion. About 8 million of the almost 14 million Americans living with cancer are over age 65, and approximately half of cancer care spending is associated with Medicare beneficiaries. Approximately 12% of active cancer patients among Medicare beneficiaries receive chemotherapy in a given year, […]
