ReCAP: The ASCO Oncology Composite Provider Utilization File: New Data, New Insights

Abstract

QUESTION ASKED: What can we learn regarding oncology practice economics from the Centers for Medicare & Medicaid Services public use files and other publicly available datasets? SUMMARY ANSWER: By combining and analyzing publicly available datasets, we are able to provide information on the distribution of supply of and demand for oncology services as well as present a clear picture of the financial risks associated with the provision of drug therapies to patients with cancer. METHODS: We combined publicly available datasets into what we call the ASCO Provider Utilization File and used it to calculate the average work performed per physician, observe regional differences in work production, and quantify the downside risk and upside potential associated with the provision of chemotherapy drugs. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: These data are limited to services provided only to Medicare fee-for-service beneficiaries and are derived from billing data submitted by noninstitutional providers only. Because Medicare data captures only approximately one half of all services provided to patients with cancer, conclusions may reflect age and reimbursement bias. REAL-LIFE IMPLICATIONS: Our analysis demonstrates significant downside financial risk associated with the provision of drug therapy to Medicare beneficiaries. This is of particular concern as it reveals the fragile nature of the complex chemotherapy delivery system that efficiently provides the right drug to the right patient at the right time. The interruption of this system in the absence of an equally effective supply chain would be extremely disruptive. [Table: see text]