Study Finds Oncology Care Is Cheaper in Community Settings Than Hospital-Based Practices

A new study has found that oncology care in hospital outpatient settings is more expensive than independent community oncology practices.

During a webinar, “Oncology Site of Care Cost Difference & Solutions,” Lucio Gordan, MD, Medical Director, Division of Quality & Informatics, Florida Cancer Specialists & Research Institute, discussed his recently published study, ““The Value of Community Oncology: Site of Care Cost Analysis.”

Gordan began by identifying the barriers to high-quality care many cancer patients face. First, there is a limited oncology work force, he said. There is a substantial amount of retiring physicians and hematologists, and it is difficult to replace them, causing a shortage. In addition, we have an aging population and many clinics in rural settings are closing because they have difficulty recruiting and retaining physicians.

Next, many have difficulty accessing affordable healthcare coverage, said Gordan. There are premium increases, disappearances of preferred provider organizations, and an unavailability of public health exchanges. Last, there is an economic strain due to economic costs, shifting payment models, practice consolidation, and administrative and regulatory changes.

According to Gordan, 75% of community practices have been acquired by hospital networks, which previous research has suggested leads to higher costs for patients.

“We are very concerned with the rapid shift from community-based oncology practices to hospital-acquired practices,” said Gordan. “We see an explosion of cost.”

The study, coauthored by Gordan and Marlo Blazer, PharmD, BCOP, Xcenda, an AmerisourceBergen Company, utilized a matched analysis of patients treated in community settings versus outpatient hospital settings for breast, lung, and colorectal cancer.

The matched analysis accounted for specific chemotherapy regimen received, receipt of radiation therapy during treatment, presence of metastatic disease, gender, surgery, and geographical difference.

The authors included 10% of a random sample of medical and pharmacy claims from the IMS LifeLink database. The database included longitudinal and integrated pharmaceutical claims for over 80 million patients from 70 health plans. The study included 6675 patients receiving chemotherapy, radiation, and/or surgery for the 3 types of cancer between July 10, 2010, and June 20, 2015. The first date of chemotherapy served as the index date for each patient.

The authors analyzed both cost differentials between each setting and the quality of care outcomes.

Results showed that the mean total price per month per patient for community practices was $12,548, whereas the mean total for hospital-based practices was $20,060, an almost $8000 difference. Chemotherapy costs were $4933 per patient per month for community-based practices, compared with $8443 for hospital-based practices. The cost of physician visits for community practices was $765 and for hospital-based practices was $3316.

Community practices also saw 28% fewer emergency department visits 3 days post-treatment and 18% fewer emergency department visits after 10 days.

The findings of this study were consistent with those of 10 previous studies conducted between 2011 and 2016.