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.

February 17, 2015

Payment Methods for Certain Cancer Hospitals Should Be Revised to Promote Efficiency, Government Accountability Office, February 2015

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 […]

Research
June 17, 2014

Location, Location, Location: Hospital Outpatient Prices Much Higher than Community Settings for Identical Services, National Institute for Health Care Reform, June 2014

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 […]

Research
June 17, 2014

Impact on Medicare Payments of Shift in Site of Care for Chemotherapy Administration, Berkeley Research Group, June 2014

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  […]

Research
May 17, 2014

Innovation in cancer care and implications for health systems, IMS Institute, May 2014

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 […]

Research
April 22, 2014

340B Covered Entity Acquisitions of Physician-based Oncology Practices, Berkeley Research Group, April 22, 2014

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 […]

Research
August 17, 2013

Cost Differences in Cancer Care Across Settings, The Moran Group, August 2013

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 […]

Research
June 17, 2013

Medicare payment differences across ambulatory settings, Medicare Payment Advisory Commission, June 2013

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 […]

Research
May 29, 2013

Results of Analyses for Chemotherapy Administration Utilization and Chemotherapy Drug Utilization, 2005-2011 for Medicare Fee- for-Service Beneficiaries, The Moran Company, May 29, 2013

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 […]

Research
March 17, 2012

Total Cost of Cancer Care by Site of Service: Physician Office vs Outpatient Hospital, Avalere Health, LLC, March 2012

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 […]

Research
October 19, 2011

Site of Service Cost Differences for Medicare Patients Receiving Chemotherapy, Milliman, October 19, 2011

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, […]

Research