Recent Trends in Medicare Payments for Outpatient Cancer Care at the End of Life

Purpose/Objective(s)

Outpatient care for end-of-life cancer patients is a significant Medicare expenditure, historically compromising 40% of all healthcare costs over the last 6 months of life. Recent FDA approvals for new and expensive biologics and growing support for lower-cost hypofractionated radiotherapy in the palliative management of advanced cancer have introduced offsetting spending effects on end-of-life care that may shift overall expenditures for this patient cohort. Our study attempts to identify current spending trends and their contributing factors through a 4-year analysis of Medicare payments for medical and radiation oncology outpatient services and supplies delivered to cancer patients over the last 6 months of life.

Materials/Methods

82,465 Medicare beneficiaries with a cancer diagnosis were identified through administrative data as having died between Jan 1 2016 and Dec 31 2019. Medicare 5% Carrier and 100% Outpatient Limited Data Set files were then abstracted of all paid claims for these beneficiaries over the last 6 months of life, and allowed charges were summed according to physician specialty and procedure/supply type. Charges were adjusted for inflation using the Consumer Price Index for medical care from the US Bureau of Labor Statistics.

Results

Among beneficiaries receiving cancer treatment services, 90% and 44% received treatment from a medical oncologist and radiation oncologist, respectively. Average expenditures per treated beneficiary increased 11% ($12366 to $13782) for medical oncology services and decreased 4% ($7983 to $7645) for radiation oncology services during the 2016 – 2019 period. Among medical oncology expense items, in-office injectable drug costs increased 42% during the study period; among radiation oncology expense items, treatment delivery costs decreased 10% during the study period. All main line-item expenses are provided in the table below. Overall spending for all medical and radiation oncology care increased 8% during the study period.

Conclusion

While costs related to end-of-life radiation oncology care have recently declined, drug costs have accelerated and account almost entirely for the observed increase in overall cost burden on Medicare and cancer patients receiving outpatient treatment over the last 6 months of life.