Outpatient chemotherapy administered in US hospitals increased by more than 150% since 2005

A new study released by The Moran Company finds that, between 2005 and 2011, the relative number of chemotherapy administration procedures performed in US hospital outpatient settings for Medicare Fee-for-Service (FFS) beneficiaries increased by more than 150% (13.5% in 2005 to 33.0% in 2011) compared to administration in physician community cancer clinics.

The study, sponsored by The US Oncology Network, Community Oncology Alliance, and ION Solutions, also reports that Medicare payments for chemotherapy administered in hospital outpatient settings have more than tripled since 2005 while payments to physician community cancer clinics have actually decreased by 14.5%.

The study documents that in 2005, when Medicare fundamentally changed reimbursement for cancer care, more than 85% of the chemotherapy was administered in physician-run community cancer clinics. A 2011 study by Milliman demonstrated that the care of a cancer patient receiving chemotherapy costs Medicare $6,500 less per patient per year and a Medicare beneficiary $650 less when the care is managed in a community cancer clinic rather than the hospital outpatient setting. More than an estimated 60% of cancer patients in the USA rely on Medicare to cover their medical costs for cancer care. Medicare reimbursement policies have resulted in an unlevel playing field causing the shift from less expensive community cancer clinics to the hospital setting. If the trend is not reversed, seniors, Medicare, and taxpayers will pay much more than is necessary to fight cancer.