{
  "abstract": "Abstract Objective To estimate the association between the billing (profit) margin and clinical benefit of cancer treatments and use by oncologists.Design Retrospective population based cohort studySetting Population based sample using fee-for-service Medicare claims data.Participants Medicare beneficiaries with an incident cancer diagnosis from 2015 to 2020; included all patients with cancer treatment indications for which the available treatment options varied in clinical benefit and billing margin.Main outcomes and measures The primary outcome was the cancer treatment each patient received among treatment options recommended by the National Comprehensive Cancer Network (NCCN). The characteristics of interest were provider billing margin (defined at the patient treatment level, using Medicare reimbursement rates corresponding to the patient’s diagnosis date) and a proxy measure of clinical benefit (rank order of treatments based on Evidence Blocks scores developed by the NCCN, corresponding to the patient’s diagnosis date). The association between treatment received, billing margin, and clinical benefit was modeled using a conditional logit model with inverse probability-of-treatment weights applied at the patient treatment level to control for patient and provider characteristics.Results Twelve cancer indications were examined comprising 19 397 individual patients. Provider billing margin ranged from $0 to $12 692 (£9440; €10 800) for each course of treatment. No association was found between a $100 increase in provider billing margin and the likelihood of treatment use (odds ratio 0.97, 95% confidence interval 0.91 to 1.03). Higher clinical benefit was associated with greater treatment use (1.62, 1.15 to 2.29).Conclusions In this observational study of Medicare beneficiaries, selection of cancer treatments was associated with the treatment’s clinical benefit but not billing margin. Therefore, it is unlikely that policy and price changes that affect the billing margin of cancer treatments would shift patterns of use.",
  "authors": [
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA",
        "Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Aaron P Mitchell"
    },
    {
      "affiliations": [
        "Department of Health Policy and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA"
      ],
      "name": "Stacie B Dusetzina"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Akriti Mishra Meza"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Grace Gallagher"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Patrick Augello"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Hannah Fuchs"
    },
    {
      "affiliations": [
        "Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Gabrielle Guzman"
    },
    {
      "affiliations": [
        "University of Illinois Chicago, Chicago, IL, USA"
      ],
      "name": "Abdullah Abdelaziz"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Sara Tabatabai"
    },
    {
      "affiliations": [
        "Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA"
      ],
      "name": "Sonia Persaud"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Nirjhar Chakraborty"
    },
    {
      "affiliations": [
        "Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Victoria S Blinder"
    },
    {
      "affiliations": [
        "Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Andrew S Epstein"
    },
    {
      "affiliations": [
        "Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Bobby Daly"
    },
    {
      "affiliations": [
        "University of Illinois Chicago, Chicago, IL, USA"
      ],
      "name": "Aaron N Winn"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Mithat Gönen"
    }
  ],
  "title": "Provider billing margin and cancer treatment selection: population based cohort study",
  "uid": "1acc8703-1b2e-5ce6-bda8-ab51b782c3b6"
}