Physician Behavior Impact When Revenue Shifted From Drugs to Services | Page 4

Published Online: April 21, 2014
Bruce Feinberg, DO; Scott Milligan, PhD; Tim Olson, MBA; Winston Wong, PharmD; Daniel Winn, MD; Ram Trehan, MD; and Jeffrey Scott, MD
Surprisingly, these findings are not revelatory, as related research into patterns of cancer care has resulted in similar observations. Morden et al found that hospice referral rates, hospitalizations, intensive care unit admissions, and chemotherapy use in the last weeks of life were remarkably uniform regardless of institution; profit versus nonprofit, academic versus community hospital, or small versus large facility.22 These direct observations imply that salaried physicians practice similarly to those reimbursed by fee-for-service methodology, despite vastly different economic incentives.

Observations from Morden and this study suggest that, contrary to prevailing dogma, medical oncology treatment selection and cancer care practice patterns may not be influenced by fee-for-service reimbursement as is often ascribed. Such observations warrant careful consideration as reimbursement methodology is modeled as part of healthcare reform. Research is ongoing to validate these observations and assess additional influences. Other value measures of our Oncology Medical Home that were believed to be both cost-saving and qualityenhancing, included physician commitment to an intensive continuous quality improvement initiative and their participation in an end-of-life care coordination program. The observations related to these components of this Oncology Medical Home pilot were separately reported at the American Society of Clinical Oncology Annual Meeting in 2013 and will be published in the near future.14-17

Take-Away Points

Increased use of chemotherapy and more expensive drugs has been correlated with the “buy-and-bill” reimbursement model; therefore, we shifted the primary source of provider revenue from drug reimbursement to professional charges in our payer-sponsored Oncology Medical Home pathways program.
  • Analysis showed that this novel reimbursement model did not alter physician prescribing behavior with regard to the type or frequency of chemotherapy administrations, or established and new patient visits.

  • These observations suggest that medical oncology treatment selection and cancer care practice patterns may not be influenced by fee-for-service reimbursement.

  • Research is ongoing to validate these observations and assess additional influences.
Author Affiliations: Cardinal Health Specialty Solutions, Dublin, OH (BF, SM, TO, JS); CareFirst BlueCross Blue Shield, Baltimore, MD (WW, DW); Greater Washington Oncology Associates, Rockville, MD (RT).

Source of Funding: None reported.

Author Disclosures: The Pathways Programs, data from which are used in this study, are a business line of Cardinal Health Specialty Solutions (CHSS). Several of the study authors are employed by and own stock in CHSS (BF, SM, TO, JS). The other authors (WW, DW, RT) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (BF, WW, RT, JS); acquisition of data (BF, SM, TO, RT, JS); analysis and interpretation of data (BF, SM, TO, DW, JS); drafting of the manuscript (BF, SM, WW); critical revision of the manuscript for important intellectual content (BF, SM, TO, JS); statistical analysis (BF, SM); administrative, technical, or logistic support (RT, JS); supervision (BF).

Address correspondence to: Bruce Feinberg, DO, 7000 Cardinal Pl, Dublin, OH 43017. E-mail: bruce.feinberg@cardinalhealth.com
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Issue: April 2014
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