Below you will find studies documenting the increasing shift in site of care delivery.
1,447 clinics/practices during the past 7 years have been impacted as follows:
- 313 clinics closed, 395 practices struggling financially.
- 45 practices sending patients elsewhere, 544 practices with a hospital agreement or purchased, 149 practices merged or acquired.
1,338 clinics/practices during the past 6 years have been impacted as follows:
- 288 clinics closed, 407 practices struggling financially.
- 43 practices sending patients elsewhere, 469 practices with a hospital agreement or purchased, 131 practices merged or acquired.
The greatest threats faced by small community-based practices:
- The 2013 ASCO census suggests that smaller community practices handle a disproportionate share of patient care, particularly in the southern and western US, yet are under far greater economic pressure than larger practices.
- 63% reported that they were likely to merge, sell or close operations in the next year.
- Looking at a list of ten routinely prescribed chemotherapies, the covered cost per dose increased by 189% in the hospital outpatient setting when compared to the oncologist’s office. The average increased cost to the patient is $134 per dose received in the hospital as an outpatient.
- As copay amounts increased, persistence fell with more than a $30 copay. This suggests even small changes in patient contribution can lead to measurable changes in drug compliance.
- The comparison of service use rates across settings leads to the conclusion that patients receive more chemotherapy administration sessions on average when treated in the outpatient hospital—and that the dollar value of chemotherapy services used is meaningfully higher in the outpatient hospital.
- Chemotherapy days per beneficiary were about 9 to 12 percent higher in the hospital outpatient department than the physician office setting across the 2009-2011 period.
- On a per beneficiary basis, hospital chemotherapy spending was approximately between 25 to 47 percent higher than physician office chemotherapy spending across the 2009-2011 period.
- On an annualized basis, taking into consideration the average number of member months that chemotherapy patients are covered by Medicare in a year, the total costs for a Pure physician-office patient and a Pure hospital outpatient patient are approximately $47,500 and $54,000, respectively.
- This produces an annual cost difference of approximately $6,500. Patient pay amounts were about 10% higher for the Pure HOP patients, which totals over $650 per patient per year.