Review of Selected Physician Practices' Procedures for Tracking Drug Administration Costs and Ability To Purchase Cancer Drugs at or Below Medicare Reimbursement Rates

EXECUTIVE SUMMARY:

The report summarizes the results of our reviews of 12 selected physician practices in the specialties of hematology, hematology/oncology, and medical oncology. 

Eleven of the twelve practices reviewed did not have procedures to track, by procedure code, the costs associated with administering drugs to cancer patients.  Without procedures for tracking these costs by procedure code, the 11 practices could not determine whether Medicare reimbursement for each code was sufficient to cover the costs of providing the services.  Nine of the twelve practices could generally purchase drugs related to 15 selected payment codes for the treatment of cancer patients at or below the reimbursement rates established by the Medicare Prescription Drug, Improvement, and Modernization Act.  The remaining three practices paid prices above the reimbursement rates for at least half of the payment codes related to the drugs purchased. 

We recommended that CMS consider the results of the review in any future evaluations of Medicare Part B reimbursement of costs associated with the administration and purchase of drugs for the treatment of cancer patients. CMS agreed with the recommendation.

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