Provider billing margin and cancer treatment selection: population based cohort study

Area of Science:

• Oncology
• Health Economics
• Clinical Decision Making

Background:

• Provider billing margins for cancer treatments vary significantly.
• Understanding factors influencing cancer treatment selection is crucial for patient care and healthcare policy.
• The National Comprehensive Cancer Network (NCCN) provides evidence-based treatment guidelines.

Purpose of the Study:

• To investigate the association between provider billing margins and clinical benefit of cancer treatments.
• To determine if billing margins influence oncologists' treatment choices.
• To assess the impact of clinical benefit on treatment utilization.

Main Methods:

• Retrospective, population-based cohort study using Medicare fee-for-service claims data (2015-2020).
• Included Medicare beneficiaries with incident cancer and treatment options with varying clinical benefit and billing margins.
• Used conditional logit models with inverse probability-of-treatment weights to analyze treatment selection based on NCCN recommendations, billing margin, and Evidence Blocks scores.

Main Results:

• Examined 12 cancer indications and 19,397 patients.
• Provider billing margin per treatment course ranged from $0 to $12,692.
• No association was found between increased billing margin and treatment use (OR 0.97, 95% CI 0.91-1.03).
• Higher clinical benefit was significantly associated with increased treatment use (OR 1.62, 95% CI 1.15-2.29).

Conclusions:

• Cancer treatment selection in Medicare beneficiaries is driven by clinical benefit, not provider billing margin.
• Policy or price changes affecting billing margins are unlikely to alter cancer treatment utilization patterns.
• Clinical benefit remains the primary determinant in oncologists' treatment decisions.