MARINA DEL REY, Calif-A detailed financial analysis of the costs
associated with chemotherapy delivery showed home health care
costs to be, on average, 2.5 times higher than those incurred
in an outpatient clinic setting, said Patrick A. Grusenmeyer,
MPA, financial administrator for the Ochsner Cancer Institute,
Speaking at the Association of Community Cancer Centers' annual
conference, Mr. Grusenmeyer said that outpatient clinic care has
been shown, as one would expect, to be a cost-effective alternative
to inpatient hospital care-sometimes up to 50% less costly. But
there are very few studies comparing the costs of outpatient care
with home health care, he said.
At the Ochsner Cancer Institute, this is not simply a theoretical
concern. The Ochsner Health Plan (jointly owned by a group of
450 physicians and Ochsner Hospital) is responsible for close
to 100,000 "covered lives" in the New Orleans area,
including the 12,000 enrolled through a Medicare-risk contract
that has been in effect since January, 1995.
"Since we bear the risks for these patients, we need to know
where we will derive the best patient care for our limited capitated
dollars," he said. One area where they found dramatically
rising total costs was home health care.
Medicare requires no deductibles or copayments for home health
care charges, which "makes it attractive to patients,"
he said. In fact, 40% of all home health care expenditures are
billed to Medicare.
Ochsner researchers decided to "look at cost, because it
is the key factor in the capitated environment we are in,"
he said. They considered evaluating charges for services, but
he observed that "in our market, we can no longer set prices,
and, therefore, charges have very little to do with the amount
of money reimbursed."
Mr. Grusenmeyer said that standard drug treatments for common
malignancies, such as breast, colon, and lung cancers, were chosen
for study, to give the results the most relevance to other centers.
A range of treatment lengths were included, as were the costs
of providing three supportive measures-transfusions, hydration,