Reimbursement and Managed Care News

By Stanton R. Mehr
Published: Friday, May 28, 2010
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Electronic Health Records Are an Elusive Goal For Office-Based Physicians

Without computerized medical records that can be transferred and viewed from one treating physician to another, experts doubt that we can advance the clinical quality and safety agenda in this country. Managed care organizations understand that electronic health records (EHRs) are the key to preventing drug–drug interactions, reducing duplicative medical testing, and better recording of patient allergies and comorbidity data, but they (and their contracted physicians) struggle with the cost of implementing these systems. As a result, according to researchers, only a small proportion of office-based physician practices have adopted these systems.

In a 2008 survey of 2,758 physicians nationwide, only 4% reported that they had a “fully functional” electronic records system. Thirteen percent indicated that they used a “basic system” (Table). Three percent had purchased but not yet implemented their EHR. Of those with a fully featured EHR, 71% stated that it was integrated with their affiliated hospital’s system. In comparison, 56% of those with basic systems have synched theirs with EHRs at their affiliated hospital.

Costs of purchase and implementation and concerns about return on investment were critical barriers to adoption, even though survey respondents indicated that EHRs would be expected to improve quality of patient care. Unfortunately, the researchers did not provide differential results based on practice specialty; they did find that primary care practices tended to utilize EHRs more frequently than specialty practices, but the responding numbers were small. It would be interesting to better understand the adoption of EHRs in community oncology practice.

In related news, the federal government acknowledged the importance and the cost of implementing electronic prescribing in its recent wrangling over the Medicare physician pay cut that was ultimately passed by Congress into law. Part of that legislation directs the Centers for Medicare & Medicaid Services to pay additional money to physicians who utilize electronic prescribing. During 2009 and 2010, physicians treating Medicare patients will get an extra 2% in their reimbursements when using E-prescribing in order to defray the costs of the system, which is estimated at $3,000 per doctor.


Freking K: Health officials tout computer prescribing. Washington Post July 21, 2008.

Change in Medicare Reimbursement Does not Result in Worse Access to Chemotherapy

When the Medicare Modernization Act of 2003 ushered in the switch to reimbursement based on average sales price (ASP) methodology, it was assumed that physicians would refer patients to other facilities to receive parenteral therapies they had been administering in their office. If that was the case, it was hypothesized that patients would find it more difficult to obtain needed parenteral treatments.

A new study published in the Journal of the American Medical Association demonstrates that patient access has been largely unaffected by the switch from “buyand- bill” incentives. Using samples from Medicare claims from the Centers for Medicare & Medicaid Services, researchers from Duke University, Durham, North Carolina, evaluated more than 5,000 incident cases of five cancer types (breast, colorectal, or lung cancer; leukemia; or lymphoma) each year from 2003 through 2006.

They found that for each year, before and after the reimbursement provisions of the Act were implemented, 70% of the patients received parenteral treatment in the physician’s office. They did find that the proportion of patients receiving chemotherapy in hospitals decreased from 2003 to 2006 (from 10.2% to 8.8%, respectively) but the proportion who received their parenteral chemotherapy in outpatient infusion centers increased slightly over that period (from 21.1% to 22.5%). These changes were statistically significant, but from 2003 to 2006, 68.7% of the patients received office-based infusions or injections. Average waiting times to receive initial chemotherapy after diagnosis increased by 0.88 days in 2006 compared with 2003. The researchers did a geographical analysis of the distance between where patients’ were given their chemotherapy relative to their home address, and they found that patients distance to receive chemotherapy increased by one mile compared with before implementation of the new ASP reimbursement formula.

They concluded that Medicare patients’ access to injectable or infusible chemotherapies were not widely affected by the changes in reimbursement mandated by the Medicare Modernization Act.


Shea AM, Curtis LH, Hammill BG, et al: Association between the Medicare Modernization Act of 2003 and patient wait times and travel distance for chemotherapy. JAMA 2008;300:189-196.

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