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21% numberincreasein theof physician-owned communityoncology clinics thatare closing.And consolidation of practice sitescontinues; of the 1,254 private communityoncology practices in the study, 392 practiceswere purchased by hospitals and 132practices had merged or were acquired bya corporate entity. 9 It is documented thatoncology consolidation will increase costsand create treatment access problemsfor cancer patients – especially in ruralareas. 7,9,10Although the provider landscape inoncology is rapidly changing, payers putthe cost of other aspects of oncology carebefore the movement from communitybasedcare to hospital-affiliated practices.However, the priorities for payers are stillcost drivers, such as the cost of hospitalizationsor the cost of high-priced productsas shown in Figure 1-1. 11Considering the increased focusby payers on the high price of new drugproducts and the cost of hospitalizationsshown in Figure 1-1, several independentresearchers have assessed the impact ofcare in hospital-owned outpatient clinicsversus private community outpatientpractices. An analysis of three years ofcommercial health-plan data revealed thatoncology patients treated in an HOPDare more costly to manage, regardless ofepisode length, and patients have higherhospitalization rates. The average cost foroffice-managed chemotherapy episodeslasting one month or more was $7,350versus $9,903 for HOPD-managed chemotherapy.A chemotherapy episode was definedas the duration between the first andlast date of chemotherapy being administeredto a patient. Compared with patientsmanaged in a community office-based setting,the average cost per chemotherapyepisode was 24 percent higher for HOPDpatients across the most common types ofcancer. 9When hospitalization rates and thesite of chemotherapy delivery were considered,14 out of 100 patients had at leastone hospitalization during their chemotherapyepisode in the hospital outpatientsetting versus 11 out of 100 patients whoreceived treatment in the office-managedsetting. 9When reviewing the overall distributionof office-managed patients receivingchemotherapy versus HOPD-managedPercentage of Payers Per Priority LevelP100%90%80%70%60%50%40%30%20%10%Payer Priorities in OncologyPriority #1High-pricednew productsPriority #2Cost ofhospitalizationsSelected Payer Prioritieschemotherapy episodes, over 78 percentof chemotherapy episodes for men wereoffice-managed compared to 70 percentof episodes for women. Patients 70 yearsof age and older utilized outpatient office-managedchemotherapy services at ahigher rate than patients 49 years of ageand younger. In Medicare patients, reportsdemonstrated that fewer patients receivechemotherapy in both hospital outpatientand physician offices, but rather select aspecific setting (n=7,128; 9.0 percent forboth settings). Primarily, Medicare patientsreceived treatment in office-basedchemotherapy centers (n=53,087; 66.9percent) versus HOPD chemotherapy(n=19,161; 24.1 percent). 10Total costs per year were higherfor Medicare patients receiving chemotherapyin hospital outpatient settings at$54,000, compared to $47,500 in the communitysetting. Similarly, patient out-ofpocketamounts were 10 percent higherfor patients receiving chemotherapy inhospital outpatient settings. 10Although existing data indicate thatthe cost of care may be higher in the outpatienthospital setting, there are limi-Priority #10Movement ofcommunity-basedcare to hospitalaffiliated practicesExtremely high priorityHigh priorityModerate priorityNeutralSomewhat priorityLow priorityNot at all a priority38 InsideOut