Utilizing 2005--2009 CMS Medicare Data to Demonstrate the Shift of Oncology Patients and Medicare Payment from the Physician Office to the Institutional Outpatient Setting

• Activity Number: 418
• Type: Contributed
• Date/Time: Tuesday, July 31, 2012 : 2:00 PM to 3:50 PM
• Sponsor: Health Policy Statistics Section
• Author(s): Zheng Wang*+ and Emma Boswell and Fotios Kokkotos
• Companies: Trinity Partners and Trinity Partners and Trinity Partners
• Keywords: Medicare ; Chemotherapy ; Longitudinal

Abstract

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) changed the way Medicare pays for drugs and drug administration services in the U.S. Since 2005, physicians who provide Part B drugs to their patients are being reimbursed at a rate of 106 percent of the average sales price (ASP). This change reduced physicians' dispensing margins and Medicare payments. This study explored the potential impact of this reform on the location in which an oncology patient receives chemotherapy treatment based on 2005-2009 CMS Medicare longitudinal claims data.

Cochran-Mantel-Haenszel tests were used to evaluate the difference in the trend of oncology patients who were on chemotherapy over 2005-2009. Longitudinal model was used to evaluate the difference in the trend of chemotherapy patient numbers and affiliated Medicare payment amounts during 2005-2009 for the institutional outpatient setting and the physician office setting. In addition, certain hospital characteristics and chemotherapy product characteristics were found to be correlated with the shift.