Another study focused on health insurance utilization demonstrated that for each cancer type evaluated, the per-member-per-month cost was significantly lower for those who received care in a community setting compared with a hospital outpatient setting (P< .001).1The cost difference applied to chemotherapy and supportive-care drugs, as well as to other related medical expenses.
This price trend is not limited to oncology care. A study of the Truven Health MarketScan Commercial Claims and Encounters Database between 2008 and 2013 found that hospital outpatient departments charged a mean of 2 to 3 times more than physician offices for similar services across different specialities.5
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The cost differential between community-based and outpatient hospital-based sites has led insurers to direct patients to primarily receive infusions from a physician’s office or an infusion center, and away from an outpatient hospital setting.6
However, insurer direction to a specific site-of-care may change in the future. The Centers for Medicare and Medicaid Services (CMS) proposed changes in hospital outpatient payment, which could take effect in 2019.7One purpose of the proposed change is to make payments more similar across sites of care, which could help resolve the limitations set by insurers on site-of-care selection.
