The cost of cancer therapies--among the most expensive in the healthcare delivery system--drive care decisions made by both patients and hospitals, but also could create tension between patients and their physicians, according to the American Journal of Managed Care.
"Care costs more for everyone in hospital-affiliated clinics," said American Journal of Pharmacy Benefits Editor Jan Berger, M.D., primarily due to facility charges. As a result, that extra charge can damage the relationship between the oncologist and his or her patient. Berger made those observations while moderating a panel of oncologists and oncology managers, the AJMC reported.
Another financial issue that could drive a wedge between the physician-hospital relationship is the 340B drug discount program. Ted Okon, executive director of the Community Oncology Alliance, observed in the article that hospitals have used the discounts at the expense of community oncology practices, making them unable to provide the drugs at competitive prices.
The 340B program has come under fire from several quarters. Hospitals were criticized for using the discounts to leverage revenue by providing those heavily discounted drugs to insured patients and charging their carriers full freight, and by providing relatively little charity care while participating in 340B.
Meanwhile, some hospitals mark up cancer drugs by huge amounts and patients have had to make often agonizing decisions about the course of their care.
"The cost issue is real," said panelist Debra Patt, M.D., of Texas Oncology. "I've had patients say, 'I can't pay for that oral chemotherapy for my renal cell carcinoma. I've decided it's in the best interest for my family for me to die.'"
The cost issue in cancer prompted the Centers for Medicare & Medicaid Services to recently propose a value-based model for oncology care, with the intent of increasing the quality of care delivered while reducing costs.
The panel of experts suggested that a medical home cancer model--where patients have their oncology care coordinated through a single physician--is the wave of the future.