Physician Prescribing Behavior Not Affected by FFS Model

Studies have identified the fee-for-service (FFS) model of physician reimbursement as a driver of healthcare resource utilization, including possible overtesting and overtreatment, according to researchers from Cardinal Health Specialty Solutions. In 2008, Cardinal Health partnered with CareFirst BlueCross BlueShield to create the first oncology Critical Care Pathway in the United States.

Based on the success of that program in cost savings and the participation and compliance of physicians, CareFirst and Cardinal Health launched the Oncology Medical Home, a second-generation pathways program, in January 2011. The new program provided a reimbursement model for physicians that shifted “the source of revenue from margin on drug utilization to cognitive services,” according to researchers. “This change would allow physicians to focus on optimal patient care without a financial incentive to prescribe chemotherapy,” they added.

The researchers recently conducted a study to evaluate behavior modification among mature pathway providers following a change in reimbursement structure as part of the Oncology Medical Home program. They reported study results during a poster session at the American Society of Clinical Oncology 2013 Annual Meeting. The poster was titled Shifting Revenue from Drug Utilization to Cognitive Services: Impact on Physician Prescribing Behavior.

The study was designed to determine (1) how physician behavior changed with participation in the Oncology Medical Home program and whether there were cost savings associated with the program; (2) if the frequency of physician evaluations would change if revenue were based on cognitive services as opposed to drug utilization; (3) if the use of chemotherapy would decrease; and (4) if there would be a shift away from branded drugs.

Practices that had participated in the initial Critical Pathways program were eligible to volunteer for the Oncology Medical Home program. In all, 31 physicians from 14 practices signed participation agreements. A total of 478 patients were enrolled in the program. Claims data were collected from April 2010 to March 2012.

The analysis found that physician behavior was not significantly modified by cognitive weighted reimbursement. There was no significant change in office visits (9.96 year 1 pre-medical home vs 10.05 year 1 post-medical home) or new patients (62% vs 63.7%, pre- and post-medical home, respectively) and no significant change in chemotherapy usage (5.93 vs 5.96 administrations per patient pre- and post-medical home, respectively). The use of generic drugs increased slightly (45.8% vs 47.6% pre- and post-medical home), the researchers said.

“Observations from the medical home pilot suggest the medical oncology treatment selection and practice patterns may not be influenced by FFS reimbursement as is often noted,” the researchers said. “Future research is ongoing to validate these observations and assess additional influences on prescribing behavior.”