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.

More information:
http://jamanetwork.com/journals/jamaoncology/fullarticle/10.1001/jamaoncol.2017.5544

Provided by JAMA