Scott Gottlieb, MD, continued the discussion, explaining that under 340B, the economics aspect is stronger on the hospital side than it ever was for Medicare.
It is well known, and well accepted, that there is an arbitrage involved in moving oncology care into the hospital, and that there are hospitals who are acquiring oncology practices for that purpose, he explained. Dr Gottlieb’s question for the panel then, is whether or not they think that the administration and Congress have done everything they are going to do with this recent legislation.
Kavita Patel, MD, MS, said that the movement for these new specialty payment models and new alternative payment models should address the arbitrage issue. Furthermore, there are sources outside of the BBA that are trying to support community-based care. Overall, whatever party comes into power in 2016, Dr. Patel expects that they will try to deal further with this issue.
Dr Gottlieb’s final question for the 2015 Oncology Stakeholders Summit asked if patients are aware of site of service differentials.
John L. Fox, MD, MHA, said no as there is little transparency around costs. “As a health plan we have been very proactive in publishing costs for different procedures, different elective procedures, different shoppable procedures. The site of service is only recently becoming an area where we have begun to focus attention on the cost differentials and even creating incentives for patients to go to lower costs sites of care,” Dr Fox elaborated.
Ted Okon, executive director of Community Oncology Alliance, agreed with Dr Fox and cited United Healthcare in Oklahoma as an example. United has tried to incentivize patients to go a physician’s office or a hospital, but because patients don’t understand site neutrality, he has received numerous phone calls from patients who see a “sky-high” bill.