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, New Orleans.
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, and antibiotics.