Is spending for infused chemotherapy by commercial insurers lower at physician offices?

Bottom Line: Delivering infused chemotherapy in a physician office was associated with lower spending by commercial health insurers compared with chemotherapy administered in a hospital outpatient department.

Why The Research Is Interesting: Insurers typically reimburse payments at a higher rate to hospital outpatient departments than physician offices, although patients may receive the same treatment. Hospitals contend they have higher overhead costs and a more medically complex patient population. Critics argue the value of a service, not overhead expenses, should set prices.

Who and When: 283,502 patients who started treatment with infused chemotherapy from 2004 through 2014 and drawn from deidentified data of patient and insurer payments

What (Study Measures): Infused chemotherapy in a physician office or hospital outpatient department (exposure); health care expenditures measured at the line-item drug level, the day level (sum of all expenditures on the day a patient received chemotherapy) and the six-month treatment-episode level (sum of all services received within six months of the start of treatment) (outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control for all the natural differences that could explain study findings.

Authors: Aaron N. Winn, Ph.D., of the Medical College of Wisconsin in Milwaukee, and coauthors

Limitations: The study cannot identify whether the cost differential was driven by facility fees and it cannot measure quality of care.

Study Conclusions: Private insurers could follow the lead of Medicare, which has started to equalize payments across care sites.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamaoncol.2017.5544)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

#  #  #

###