AJMC: Study Suggests Link Between Medicare Payment Models and Cancer Supplement Prescription Practices

A new study from The American Journal of Pharmacy Benefits finds that physicians who treat cancer patients may be influenced by the reimbursement policies of the Medicare claim processors that pay them.

FOR IMMEDIATE RELEASE

August 27, 2013

AJPB: Study Suggests Link Between Medicare Payment Models and Cancer Supplement Prescription Practices

PLAINSBORO, NJ — A new study from The American Journal of Pharmacy Benefits finds that physicians who treat cancer patients may be influenced by the reimbursement policies of the Medicare claim processors that pay them. The findings also report that bundled payments, wherein all items and services given during an episode of care are paid for in one lump sum, had lower reimbursement amounts than those models that paid doctors separately for each service. This suggests that differences in Medicare reimbursement models can lead to variations in physician care delivery practices.

The study, conducted by West Virginia University researchers Dr. Xiaoyun Pan, and Dr. Usha Sambamoorthi, specifically analyzed non-Hodkin lymphoma (NHL) patients who received granulocyte colony-stimulating factor (G-CSF) as a supplement to their cancer treatment. G-CSF is used to accelerate a patient's recovery from neutropenia after chemotherapy.

“G-CSF is listed as one of the top 10 most expensive Medicare Part B drugs, with average reimbursement amounts for 11 days of supply ranging from $2136 to $3442,” wrote the study authors. “Thus, augmenting chemotherapy with G-CSF may provide increased revenue for the physicians.”

Research findings revealed that G-CSF prescription was less likely in locations with higher physician reimbursement models when compared to those processors with lower average physician reimbursement amounts. While the study did not specifically ask for physicians reasoning in prescribing the supplementary drug, the authors speculate that variation in G-CSF use is likely directly linked with low reimbursement amounts.

“Under the income effect theory, physicians contracting with Medicare claim processors with low reimbursement amounts may have low income and hence may need to increase their income by providing supplemental services and products,” the study said. “Thus in our case, physicians contracting with Medicare claim processors with low reimbursement amount may augment standard chemotherapy regimens with G-CSF for patients with NHL and therefore may be more likely to prescribe G-CSF.”

The authors suggest that while their study provides insight to the association between bundled payment policies and the provision of care for patients with NHL, future studies are needed to obtain the actual payment policies at the claim processor level. Such research could further explain the relationship between bundled payments and physician practice patterns.

Read the article here.

CONTACT: Nicole Beagin

609-716-7777 x131

nbeagin@ajmc.com