Abstract Types

CRA
Clinical Review Abstract

LBA
Late-Breaking Abstract

TPS
Trials in Progress Abstract

e
Abstracts selected for publication but not presentation at the Annual Meeting

^
Abstracts granted an exception in accordance with ASCO's Conflict of Interest Policy



Shifting revenue from drug sales to cognitive services: Impact on physician prescribing behavior.

Sub-category:
Outcomes and Quality of Care

Category:
Health Services Research

Meeting:
2013 ASCO Annual Meeting

Abstract No:
6629

Citation:
J Clin Oncol 31, 2013 (suppl; abstr 6629)

Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2013 Annual Meeting but not presented at the Meeting, can be found online only.

Author(s): Bruce A. Feinberg, Joseph Cooper, Winston Wong, Daniel Winn, Tim Olson, Ram Swarup Trehan, Jeffrey A. Scott; Cardinal Health Specialty Solutions, Dublin, OH; CareFirst BlueCross BlueShield, Baltimore, MD; CareFirst BlueCross Blue Shield, Baltimore, MD; Greater Washington Oncology Associates, Rockville, MD

Abstract Disclosures


Abstract:

Background: Extensive literature has cited fee-for-service physician reimbursement methodology as a critical driver of resource utilization constituting overtesting, overtreatment, and an impediment to bending the cost curve in cancer care. CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions to launch the first cancer clinical pathway in the US in Aug 2008. Physician participation was voluntary and reimbursement remained fee-for-service. Due to its early success with regard to savings and physician participation and compliance, an oncology medical home (MH) program was piloted in Jan 2011 offering a new physician reimbursement model, which shifted the source of revenue from margin on drug sales to cognitive services. This would allow physicians to focus on optimal patient (pt) care without the financial incentive to prescribe chemotherapy (chemo). We analyzed physician behavior modification after this change in reimbursement structure 1 year after implementation of the MH program. Methods: Practices that participated in the first pathways program were eligible to join the MH program. Claims data from CFBCBS were collected from Apr 2010 to Mar 2012. New and established pt visits, chemo administrations (admins) per pt and per practice, and % generic drug use were compared for year +1 versus year -1 of the MH program. Results: Fourteen practices (31 physicians, 478 pts) joined the MH program. In year +1, new pt visits increased by 2.7%, visits per established pt increased 1%, chemo admins per pt increased by 3%, and the percentage of regimens utilizing all generic drugs increased by 3.9%. Conclusions: Switching financial incentives from drug administration toward cognitive services did not significantly alter physician behavior with regard to the type or frequency of chemo admins or the frequency of pt visits. Whether this is because the physicians were mature pathways participants, influenced by brand-name prescription drug detailing, following National Comprehensive Cancer Network guidelines, or influenced by cognitive dissonance is speculative. Assumptions regarding fee-for-service reimbursement may not be applicable to chemo and will be further studied.

 

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1. Association between high-cost imaging and hospice use at the end of life of cancer patients.

Meeting: 2013 ASCO Annual Meeting Abstract No: 6504 First Author: M. A. Dinan
Category: Health Services Research - Outcomes and Quality of Care

 

2. Use of high-intensity surveillance in patients following a diagnosis of stage I-II non-small cell lung cancer.

Meeting: 2013 ASCO Annual Meeting Abstract No: 6505 First Author: J. D. Wright
Category: Health Services Research - Outcomes and Quality of Care

 

3. Choosing mastectomy over lumpectomy: Factors associated with surgical decisions in young women with breast cancer.

Meeting: 2013 ASCO Annual Meeting Abstract No: 6507 First Author: S. M. Rosenberg
Category: Health Services Research - Outcomes and Quality of Care

 

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