The Alliance for Patient Access / IfPA’s Patient Access Policy Blog / Cancer Care Access Threatened by Payment Disparity

Cancer Care Access Threatened by Payment Disparity

by Amanda Conschafter, Blog Editor

Data suggests the costs of chemotherapy may vary dramatically depending on the care setting.  As President Obama extends the deadline for Americans to enroll in a government health insurance plan, debates about cost of care have brought the issue of Medicare payment disparities, though not new, back to the forefront.

Studies find that Medicare can be billed 25 to 47 percent more for outpatient chemotherapy services at their local hospital than they may at a community care center.  Varying factors include the number of lines of chemotherapy administered and the cost of the chemotherapy drugs provided.

Hospitals, however, contend that they shoulder more expenses and therefore need higher compensation to stay financially viable.  Hospital advocates also argue that hospitals treat the sickest patients, which accounts for their higher costs.

Even with the lower costs, many patients maintain that their experience and level of service is better at community cancer centers. Anecdotal evidence suggests that chemotherapy can be administered with less wait time and that the patient-staff relationship is more personal.

Despite the apparent costs savings and high levels of patient satisfaction, the irony is that both Medicare payment policies and the Affordable Care Act my be incentivizing treatment in the hospital setting and causing community centers to close. The result of which would be to limit cancer patient access to lower cost and high quality care.

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The Alliance for Patient Access is a national network of physicians dedicated to ensuring patient access to approved therapies and appropriate clinical care.
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