Oncology & Hematology Coding Alert

Oncologists favor a panel of health experts to decide Medicare payments based on cost-benefit analysis.

Gogineni and colleagues (July 2012 - March 2013) conducted a survey causes of high health care costs in the US. The results of this survey have been published in the Journal of Clinical Oncology (J Clin Oncol. 2015;33:846-853). The survey, completed by 326 patients with cancer with appointments at the University of Pennsylvania’s Abramson Cancer Center, 250 oncologists and hematologists, and 891 members of the general public, viewed Medicare costs as a substantial problem.

The survey explored more about the following three questions:

1. What is the magnitude of problem posed by Medicare spending?

More than 75% of patients, oncologists, and the general public perceived Medicare spending to be moderate or big problem and more than 65% of all respondents thought Medicare spending could be reduced “without denying anyone health care that really helps them.”

2. What are the factors responsible for increasing health care costs?

When asked about six (6) potential factors that increase Medicare spending, most respondents rated drug company pricing and insurance company profits as the top two (2) contributors to the problem. However, physicians and hospitals were perceived to be equal contributors.

Unnecessary tests and treatments were believed to contribute to and add a moderate or a large amount to Medicare costs by 70.3% of oncologists, 69.1% of patients with cancer, and 80.9% of the general public respondents. Additionally, 66.9% of patients with cancer and 79.4% of the public thought hospitals or doctors committing “fraud by submitting bills for services not provided” contributes significantly to high Medicare costs. However, only 19.2% of oncologists agreed for this practice.

Excessive physician charges were believed to add to Medicare costs by 81.0% of the public, 58.0% of patients, and 18.8% of oncologists.

3. What are the potential solutions to reduce Medicare expenditures?

Reference pricing: More than 75% of respondents supported that Medicare should refuse to pay for more expensive treatments when an equally effective and less expensive treatment is available.

Means testing: Respondents in all three groups believed that patients with more financial resources can pay a larger portion of their costs.

Expert panel: 45.7% of the public, 32.8% of patients, and 63.6% of oncologists favored having an independent panel of experts like the National Institute for Health and Care Excellence (NICE) in the United Kingdom. This panel would analyze the cost and benefits of each treatment and decide which ones Medicare can really pay for.

However, most respondents did not favor having an annual ceiling for the amount that Medicare would spend on a person as only 12.9% of patients, 16.8% of oncologists, and 28.3% of the general public supported this proposed solution.