Documentation of Chemotherapy Infusion Preparation Costs in Academic- and Community-Based Oncology Practices

Authors:
Diana I. Brixner From University of Utah Pharmacotherapy Outcomes Research Center, Salt Lake City, Utah; Fairfax-Northern Virginia Hematology/Oncology, Fairfax, Virginia; and University of Utah Hospital Pharmacy Services, Salt Lake City, Utah.

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 RPh, PhD
,
Gary M. Oderda From University of Utah Pharmacotherapy Outcomes Research Center, Salt Lake City, Utah; Fairfax-Northern Virginia Hematology/Oncology, Fairfax, Virginia; and University of Utah Hospital Pharmacy Services, Salt Lake City, Utah.

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 PharmD, MPH
,
Nancy A. Nickman From University of Utah Pharmacotherapy Outcomes Research Center, Salt Lake City, Utah; Fairfax-Northern Virginia Hematology/Oncology, Fairfax, Virginia; and University of Utah Hospital Pharmacy Services, Salt Lake City, Utah.

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 PhD
,
Roy Beveridge From University of Utah Pharmacotherapy Outcomes Research Center, Salt Lake City, Utah; Fairfax-Northern Virginia Hematology/Oncology, Fairfax, Virginia; and University of Utah Hospital Pharmacy Services, Salt Lake City, Utah.

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 MD
, and
James A. Jorgenson From University of Utah Pharmacotherapy Outcomes Research Center, Salt Lake City, Utah; Fairfax-Northern Virginia Hematology/Oncology, Fairfax, Virginia; and University of Utah Hospital Pharmacy Services, Salt Lake City, Utah.

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 RPh, MS
Volume/Issue:
Volume 4: Issue 3
Online Publication Date:
Mar 2006
DOI:
https://doi.org/10.6004/jnccn.2006.0020
Full access

Significant changes in Medicare reimbursement for outpatient oncology services were proposed as part of the Medicare Modernization Act of 2003. The purpose of this study was to identify the “true cost” associated with drug-related handling for the preparation and delivery of chemotherapy doses to estimate the impact of changing reimbursement schema by Medicare. Two academic medical outpatient infusion centers and 2 community cancer centers provided data used to estimate all costs (excluding drug cost) associated with the preparation of chemotherapy doses. The data included both fixed costs (drug storage, space, equipment, and information resources) and variable costs (insurance management, inventory, waste management, pharmacy staff payroll, supplies, and shipping). The average cost for the preparation of chemotherapy doses across all sites was $34.27 (range, $32.08–$41.23). A time-and-motion study was also performed to determine what tasks were conducted by pharmacy staff and how much time was spent in the preparation of the top 15 chemotherapeutic drugs and regimens used in the 4 sites. Data from the 4 centers was projected to show that if 3,990,495 million chemotherapy infusions were administered to a national Medicare population in 2003, when multiplied by the average cost of preparation for infusions determined by the current study ($34.27), the estimated total annual cost to Medicare for chemotherapy preparation by pharmacists is $136,754,263.65. The pharmacists spent most of their days (90% or more) performing tasks directly related to the preparation of these agents. These data provide scientific support for the consideration of appropriate reimbursement for chemotherapy services provided by pharmacists to Medicare beneficiaries.

Correspondence: Diana I. Brixner, RPh, PhD, University of Utah Pharmacotherapy Outcomes Research Center, 421 Wakara Way, Suite 208, Salt Lake City, UT 84108. E-mail: dbrixner@hsc.utah.edu.
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  • 1.

    Cowan C, Catlin A, Smith C et al.. National Health Expenditures, 2002. Health Care Financ Rev 2004;25:143–166.

  • 2.

    Keehan SP, Lazenby HC, Zezza MA et al.. Age estimates in national health accounts. Health Care Financ Rev December 2004. Available at: http://www.cms.hhs.gov/healthcarefinancingreview/downloads/keehan.pdf. Accessed January 30, 2006.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Medicare Prescription Drug, Modernization, and Improvement Act of 2003. Public Law No. 108-173 (2003).

  • 4.

    Davenport-Ennis N. National Patient Advocate Foundation. September 24, 2004 (Letter). NPAF makes comments on CMS proposed rule CMS-1429-P. Available at: http://www.npaf.org/news.php?p=297. Accessed January 2006.

    • PubMed
    • Export Citation
  • 5.

    Iglehart JK. The new medicare prescription drug benefit—a pure power play. N Engl J Med 2004;350:826–833.

  • 6.

    Doherty RB. Assessing the new medicare prescription drug law. Ann Int Med 2004;141:391–395.

  • 7.

    Meyer BM, Cantwell KM. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003: implications for health-system pharmacy. Am J Health Syst Pharm 2004;61:1042–1051.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Kleinke JD. Re-naming and re-gaming: medicare's doomed attempt to reform reimbursement for injectable drugs. Health Affairs 2004. Available at: http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.561v1. Accessed January 2006.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Weir HK, Thun MJ, Hankey BF et al.. Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for cancer prevention and control. J Nat Cancer Inst 2003;95:1276–1299.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Hoffman JM, Shah ND, Vermeulen LC et al.. Projecting future drug expenditures—2005. Am J Health Syst Pharm 2005;62:149–167.

  • 11.

    Chang S, Long SR, Kutikova L et al.. Estimating the costs of cancer: results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000. J Clin Oncol 2004;22:3524–3530.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Roberts MJ. Work measurement. In: Brown TR, Smith MC (eds). Handbook of Institutional Pharmacy Practice. Baltimore, MD: Williams & Wilkins; 1986, p. 90–110.

  • 13.

    Annual Report of the Boards of Trustees. Centers for Medicare & Medicaid Services Web site. Available at www.kff.org/medicare/loader.cfmPurl-/commonspot/security/getfile.cfm&PageID=33319. Accessed January 30, 2006.

    • PubMed
    • Export Citation
Copyright:
Copyright © 2006 by the National Comprehensive Cancer Network
Page Numbers:
12
Article Category:
Research Article
Received:
21 Jul 2005
Accepted:
11 Jan 2006
Print Publication Date:
01 Mar 2006
Online Publication Date:
Mar 2006
Keywords:
Chemotherapy reimbursement; pharmacy costs; therapy management; fixed costs
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