When reimbursement methodologies change, community cancer centers are often shocked when those changes negatively impact on the bottom line.  “Change is inevitable. It is more important than ever to understand reimbursement changes and trends,” writes Bonnie Kirschenbaum, MS, FASHP, FCSHP, a senior healthcare consultant. “Community cancer centers that do not keep current risk possible financial ruin, audits, and investigations.”  Sources for additional reimbursement information include the following:9

  • Center for Medicare and Medicaid Services (CMS) Web site – www.cms.gov
  • American Society of Health-System Pharmacists – www.ashp.org

Each time payment cuts are mandated in CMS, administrators sound the alarm. “Hospitals [and practices] administering outpatient chemotherapy will go out of business” asserted Lee E. Mortenson, executive director, Association of Community Cancer Centers (ACCC), referring to a set of cutbacks that took place in 2002.10 According to Martha Polovich, PhD, RN, AOCN, Director, Clinical Practice, Nursing Research and Education, Duke Oncology Network, “Oncology will not go back to the olden times nor will a return to the era when almost all chemotherapy was given in the inpatient setting because the advantages of outpatient administration, whether in the home or in the office, are too profound.” However, Dr. Polovich also stated, “That the only time when outpatient chemotherapy management is disadvantageous is when drugs need to be administered continuously for 24 hours or more, and patients require close observation during those infusions.” 

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The advantages of outpatient chemotherapy are significant, and for the majority of patients, the positives of outpatient chemotherapy care far outweigh the negatives.  The advantages include:2

  • Safe, easy drug administration;
  • Respects patient’s wish to avoid hospitalization;
  • Familiar and safe facility enhances patient’s physical comfort and psychological well-being;
  • Oncologist has direct and immediate control of administration of chemotherapy;
  • Overnight stay and expense avoided;
  • Facilitates tracking and control of treatment costs;
  • Treatment administered at patient’s convenience.

A study done by Robinson and colleagues demonstrated that even intraperitoneal (IP) therapy, in the treatment of ovarian cancer, is better administered in the outpatient setting. The study found that IP infusion in a hospital environment tends to result in poorer outcomes than those achieved in an outpatient setting.  Patients treated on an inpatient hospital basis completed fewer courses, had more adverse events, and needed more time to finish individual treatments, and were less compliant than those patients treated as outpatients.  The reason for a poorer outcome in hospitalized patients seemed to result from insufficient resources, including the inadequately trained personnel involved in this very specialized task.11