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Practice and Hospital Site of Service CostsUnderstanding and Utilizing Comparative Data

Community Oncology Alliance

Managed Care Digest Series®

Richard Frye, Ph.D., General Editor

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National Patient Counts, 2011

PHYSICIAN OFFICE

HOSPITAL OUTPATIENT TOTAL

TUMOR TYPE

Colorectal Cancer 64,203 (58%) 46,165 (42%) 110,368

Prostate Cancer 217,054 (73%) 79,993 (27%) 297,047

TUMOR TYPE ICD-9 CODES

Colorectal Cancer

153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9, 154.0, 154.1, 154.8

Prostate Cancer 185

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The IMS Health analysis of claims data focuses specifically on prostate and colorectal cancer. Information was obtained through the use of the standard Healthcare Common Procedure Coding System (HCPCS) utilizing J-codes for the billing of chemotherapy and other forms of treatment.

These data are obtained from two proprietary databases that are maintained by IMS Health. One database uses claims data from physicians’ offices and clinics (CMS 1500); the other is based on hospital outpatient charges (charge data master or CDM). IMS Health uses algorithms to project its data to national and regional levels. These two data sets can be viewed in parallel but not commingled.

The data reporting period is the full calendar year of 2011, with a look back through the patient’s medical history to assign cancer diagnoses. Patients diagnosed and treated for prostate or colorectal cancer were tracked if they received chemotherapy or hormone therapy.

Data Methodology: IMS Patient Claims Data

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Regional Breakdown

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Percentage of Colorectal Cancer Patients, by Age Group, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION

0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Central 6.6% 42.1% 27.7% 20.2% 3.1% 8.2% 42.5% 25.2% 18.4% 5.5%

Northeast 6.2% 41.6% 26.4% 22.1% 3.4% 6.3% 38.0% 26.2% 22.3% 7.0%

Southeast 5.9% 37.5% 30.8% 22.0% 3.6% 9.6% 47.3% 25.5% 13.9% 3.4%

Southwest 6.3% 40.2% 29.7% 20.6% 2.9% 7.4% 45.2% 27.3% 15.8% 3.9%

West 6.8% 41.4% 27.5% 20.6% 3.4% 8.6% 42.1% 26.3% 16.9% 5.8%

NATION 6.3% 40.5% 28.5% 21.1% 3.3% 7.9% 42.9% 26.0% 17.8% 5.1%

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Percentage of Prostate Cancer Patients, by Age Group, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION 0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Central 0.1% 25.6% 36.1% 31.7% 6.3% 0.3% 29.5% 36.0% 25.9% 8.2%

Northeast 0.3% 26.5% 35.4% 31.3% 6.4% 0.3% 26.9% 35.1% 28.4% 9.0%

Southeast 0.3% 22.0% 38.2% 33.4% 5.9% 0.5% 32.2% 39.0% 22.6% 5.5%

Southwest 0.2% 24.8% 38.7% 30.9% 5.2% 0.3% 30.9% 37.8% 23.9% 6.9%

West 0.2% 23.3% 37.0% 32.6% 6.6% 0.3% 25.9% 36.9% 27.3% 9.4%

NATION 0.2% 24.3% 37.1% 32.1% 6.1% 0.4% 29.2% 36.9% 25.7% 7.6%

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Percentage of Colorectal Cancer Patients, by Payer

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

REGION 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011

Central 49.6% 45.9% 6.0% 7.0% 44.3% 47.0% 28.7% 27.2% 4.6% 5.1% 66.6% 67.5%

Northeast 39.4% 37.8% 6.8% 8.5% 53.7% 53.6% 29.8% 26.8% 5.4% 5.5% 64.6% 67.6%

Southeast 52.6% 51.5% 6.1% 6.6% 41.1% 41.7% 18.7% 16.2% 5.0% 4.8% 76.2% 78.8%

Southwest 51.4% 50.3% 5.4% 5.3% 43.1% 44.3% 22.1% 20.6% 8.2% 8.4% 69.5% 70.8%

West 39.8% 40.5% 5.5% 5.5% 54.6% 53.9% 17.7% 17.1% 8.3% 8.8% 73.8% 74.0%

NATION 46.7% 45.6% 5.9% 6.5% 47.2% 47.8% 24.0% 21.9% 5.8% 5.9% 70.1% 72.0%1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

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Percentage of Prostate Cancer Patients, by Payer

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

REGION 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011

Central 62.5% 60.6% 1.8% 2.0% 35.5% 37.3% 40.7% 37.3% 1.6% 1.7% 57.6% 60.9%

Northeast 50.3% 49.1% 3.3% 4.0% 46.2% 46.8% 36.3% 33.0% 2.5% 2.4% 61.1% 64.5%

Southeast 66.3% 65.6% 1.9% 1.6% 31.7% 32.6% 25.2% 22.1% 1.8% 1.7% 72.9% 76.0%

Southwest 62.5% 62.5% 2.5% 1.8% 34.9% 35.5% 32.0% 27.0% 3.6% 3.0% 64.2% 69.8%

West 58.4% 57.6% 1.9% 1.7% 39.6% 40.6% 18.1% 16.5% 3.0% 3.2% 78.8% 80.1%

NATION 60.5% 59.6% 2.2% 2.2% 37.1% 38.0% 31.0% 27.8% 2.3% 2.3% 66.6% 69.8%1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

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PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION 2010 2011 2010 2011

Central 28.8% 29.3% 35.7% 38.2%

Northeast 23.5% 24.9% 26.1% 25.7%

Southeast 25.3% 25.3% 34.5% 36.1%

Southwest 25.7% 26.1% 31.0% 33.0%

West 28.5% 29.5% 31.1% 31.7%

NATION 26.3% 26.9% 31.2% 32.1%

Percentage of Colorectal Cancer Patients with Metastatic Cancer

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Percentage of Prostate Cancer Patients with Metastatic Cancer

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION 2010 2011 2010 2011

Central 5.5% 5.8% 13.8% 14.3%

Northeast 5.2% 5.9% 8.5% 9.2%

Southeast 5.0% 5.4% 11.6% 12.1%

Southwest 6.3% 7.0% 12.0% 12.8%

West 8.3% 8.9% 11.3% 10.7%

NATION 5.8% 6.3% 10.8% 11.2%

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Percentage of Colorectal Cancer Patients with Metastatic Cancer, by Payer

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

REGION 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011

Central 27.2% 26.6% 30.0% 30.0% 30.0% 31.5% 36.9% 40.8% 41.3% 45.1% 34.7% 36.4%

Northeast 21.3% 22.2% 30.9% 34.1% 24.0% 25.2% 27.5% 27.2% 25.9% 27.3% 25.5% 24.9%

Southeast 23.6% 23.5% 31.1% 28.8% 26.5% 26.9% 33.7% 35.8% 34.0% 41.7% 34.5% 35.8%

Southwest 23.9% 23.9% 35.2% 34.0% 26.5% 27.5% 30.3% 32.5% 36.6% 36.9% 30.5% 32.6%

West 25.9% 25.4% 34.5% 34.5% 29.7% 31.7% 33.3% 28.7% 37.3% 34.1% 29.9% 31.9%

NATION 24.4% 24.3% 32.2% 32.3% 27.3% 28.5% 31.3% 32.4% 32.8% 35.6% 31.0% 31.8%1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

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Percentage of Prostate Cancer Patients with Metastatic Cancer, by Payer

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

REGION 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011

Central 5.8% 6.3% 11.1% 10.0% 4.5% 4.6% 14.5% 16.9% 18.8% 17.6% 12.8% 12.6%

Northeast 5.8% 6.5% 3.0% 5.0% 4.3% 4.9% 10.2% 11.2% 8.0% 8.3% 7.4% 8.1%

Southeast 5.4% 5.8% 5.2% 6.3% 3.5% 4.3% 11.5% 13.6% 16.7% 11.8% 11.5% 11.4%

Southwest 7.0% 7.8% 8.0% 11.1% 4.6% 5.1% 11.6% 13.7% 13.9% 20.0% 12.0% 12.0%

West 8.9% 9.4% 10.5% 11.8% 7.3% 7.9% 14.4% 13.9% 13.3% 12.5% 10.4% 9.9%

NATION 6.3% 6.9% 9.1% 9.1% 4.9% 5.3% 11.6% 12.9% 13.0% 13.0% 10.2% 10.3%1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

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Average Number of Cycles for Colorectal Cancer Patients, by Age Group, 2011

Physician Office Hospital Outpatient

REGION 0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Central 7 8 7 7 8 6 6 7 6 6

Northeast 7 7 7 7 8 6 7 7 7 8

Southeast 7 7 7 7 6 6 7 6 7 7

Southwest 8 8 8 7 6 6 6 6 6 —

West 7 7 7 7 7 4 5 4 5 —

NATION 7 7 7 7 7 6 6 6 6 8

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Average Length of Therapy (Days) for Colorectal Cancer, by Age Group, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION 0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Central 153 176 172 170 230 144 181 181 168 163

Northeast 154 171 165 181 196 154 177 191 176 199

Southeast 153 169 170 212 148 147 169 149 171 124

Southwest 159 164 176 165 142 143 153 146 137 —

West 142 159 172 163 158 104 143 125 104 —

NATION 152 168 171 179 183 147 170 171 167 161

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Average Number of Cycles for Prostate Cancer Patients, by Age Group, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION 0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Central — 6 5 5 6 5 3 4 4 5

Northeast 4 6 6 5 5 3 5 5 5 5

Southeast — 6 6 5 5 9 5 5 4 4

Southwest 4 5 6 5 6 4 5 5 5 6

West — 5 5 5 4 — 3 4 3 5

NATION 5 6 6 5 5 4 5 5 5 5

NOTE: Some regimen metric data were unavailable for the selected regions.

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Average Length of Therapy (Days) for Prostate Cancer Patients,by Age Group, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION 0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Central 205 200 172 150 294 85 105 112 124 101

Northeast — 172 181 157 196 62 127 152 149 164

Southeast — 171 176 178 191 176 138 141 130 88

Southwest 118 174 196 147 229 84 176 195 137 86

West — 173 164 167 176 — 130 102 73 214

NATION 148 178 180 161 215 105 136 145 137 144

NOTE: Some regimen metric data were unavailable for the selected regions.

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Average Number of Cycles for Colorectal Cancer Patients, by Payer

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

REGION 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011

Central 7 7 7 6 7 8 7 7 6 6 6 6

Northeast 7 7 7 7 7 8 7 7 6 6 6 7

Southeast 8 7 7 7 7 7 6 6 6 7 5 6

Southwest 7 7 7 7 8 8 7 7 7 6 5 6

West 7 7 6 6 8 7 5 5 5 4 4 5

NATION 7 7 7 6 7 8 7 7 6 6 5 61 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

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Average Length of Therapy (Days) for Colorectal Cancer Patients, by Payer

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

REGION 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011

Central 212 178 165 148 193 171 203 190 186 162 187 169

Northeast 207 179 187 142 202 168 229 208 157 152 185 172

Southeast 220 187 173 156 197 165 203 184 190 171 170 155

Southwest 209 175 163 137 190 164 198 195 196 153 138 134

West 195 174 141 148 181 155 151 134 142 120 140 133

NATION 210 179 168 147 192 165 211 195 177 158 173 1601 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

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Average Number of Cycles for Prostate Cancer Patients, by Payer

NUMBER OF CYCLES LENGTH OF THERAPY (DAYS)

Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

REGION 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011

Central 6 6 3 7 5 5 5 4 5 3 5 4

Northeast 6 6 9 6 7 5 6 6 4 5 5 5

Southeast 6 6 6 6 5 5 6 5 4 5 4 5

Southwest 6 6 5 6 6 5 4 6 7 6 4 4

West 6 5 5 4 6 5 3 5 4 4 3 3

NATION 6 6 6 6 6 5 5 5 5 5 4 51 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

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Average Length of Therapy (Days) for Prostate Cancer Patients, by Payer

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

REGION 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011

Central 236 183 60 162 185 168 140 125 154 — 121 101

Northeast 212 173 258 117 224 173 211 160 138 128 153 136

Southeast 215 177 218 165 192 178 175 138 207 203 141 131

Southwest 231 181 198 169 182 166 188 195 283 155 131 159

West 200 160 151 112 216 187 140 181 211 162 88 98

NATION 218 175 203 151 204 175 184 152 202 155 138 1321 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.NOTE: Some hospital outpatient regimen metrics were unavailable for the selected regions.

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Average Annual Charges, by Age Group, Colorectal Cancer, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION 0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Central $32,865 $36,922 $31,843 $27,601 $22,550 $91,415 $86,424 $94,272 $73,940 $94,816

Northeast $29,427 $33,114 $26,037 $23,030 $23,401 $104,475 $108,221 $106,073 $96,949 $81,207

Southeast $48,870 $47,926 $45,724 $38,035 $30,368 $106,207 $128,399 $109,342 $88,709 $67,463

Southwest $68,032 $65,522 $54,985 $46,572 $32,098 $81,810 $84,959 $98,019 $82,637 $83,543

West $50,074 $46,891 $43,446 $33,459 $32,937 $84,234 $94,175 $87,632 $83,213 $71,630

NATION $45,509 $45,841 $40,281 $33,197 $28,013 $99,791 $108,805 $103,902 $89,965 $79,227

NOTE: Regarding Medicare reimbursement, hospitals and physicians' offices use the same billing codes, but rates differ. Medication charges incurred in a physician's office are usually paid at contracted rates, which can be lower than billed charges. Hospitals generally pay less for chemotherapy and are reimbursed at lower rates, but receive fees that include average sales price (ASP) + 6% in the physician office setting. Separately paid drugs in hospital outpatient departments are expected to be reimbursed at ASP + 4% in 2013.

• Physician office claim charges include only those drug charges administered in the office setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with physician office administrative service charges.

• Hospital outpatient charges incorporate all aspects of care, including direct (i.e., pharmacy, imaging, administrative provider services) and indirect (i.e., financial services, information technology, operations expenses) overhead.

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Average Annual Charges, by Age Group, Prostate Cancer, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION 0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Central $21,142 $42,548 $36,855 $41,637 $23,234 $91,501 $70,182 $86,932 $82,294 $82,348

Northeast $58,645 $45,269 $37,944 $33,437 $17,063 $37,006 $77,994 $89,790 $78,359 $68,169

Southeast — $62,756 $51,664 $38,067 $21,503 $37,655 $86,573 $101,150 $106,560 $92,335

Southwest $31,993 $52,911 $49,080 $43,148 $26,543 $30,428 $61,514 $59,212 $55,985 $88,520

West $11,110 $38,096 $39,315 $28,525 $12,115 $24,756 $56,399 $80,183 $71,171 $45,867

NATION $22,800 $48,330 $44,062 $36,480 $19,575 $41,297 $76,550 $89,370 $84,943 $75,083

NOTE: Regarding Medicare reimbursement, hospitals and physicians' offices use the same billing codes, but rates differ. Medication charges incurred in a physician's office are usually paid at contracted rates, which can be lower than billed charges. Hospitals generally pay less for chemotherapy and are reimbursed at lower rates, but receive fees that include average sales price (ASP) + 6% in the physician office setting. Separately paid drugs in hospital outpatient departments are expected to be reimbursed at ASP + 4% in 2013.

• Physician office claim charges include only those drug charges administered in the office setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with physician office administrative service charges.

• Hospital outpatient charges incorporate all aspects of care, including direct (i.e., pharmacy, imaging, administrative provider services) and indirect (i.e., financial services, information technology, operations expenses) overhead.

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Average Annual Charges, by Payer, Colorectal Cancer, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

Central $33,260 $36,205 $33,548 $100,468 $76,780 $83,470

Northeast $26,843 $27,047 $30,638 $95,841 $76,263 $112,082

Southeast $45,441 $41,387 $46,347 $99,753 $125,117 $119,788

Southwest $53,441 $57,902 $65,199 $119,353 $99,465 $77,079

West $41,077 $43,670 $45,881 $62,962 $60,604 $103,340

NATION $40,418 $40,532 $43,492 $99,154 $93,379 $106,950

1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

NOTE: Regarding Medicare reimbursement, hospitals and physicians' offices use the same billing codes, but rates differ. Medication charges incurred in a physician's office are usually paid at contracted rates, which can be lower than billed charges. Hospitals generally pay less for chemotherapy and are reimbursed at lower rates, but receive fees that include average sales price (ASP) + 6% in the physician office setting. Separately paid drugs in hospital outpatient departments are expected to be reimbursed at ASP + 4% in 2013.

• Physician office claim charges include only those drug charges administered in the office setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with physician office administrative service charges.

• Hospital outpatient charges incorporate all aspects of care, including direct (i.e., pharmacy, imaging, administrative provider services) and indirect (i.e., financial services, information technology, operations expenses) overhead.

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Average Annual Charges, by Payer, Prostate Cancer, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

REGION Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

Central $38,066 $25,730 $41,697 $81,954 $97,147 $79,841

Northeast $36,914 $23,808 $35,355 $86,459 $66,168 $79,845

Southeast $44,392 $43,036 $52,546 $104,997 $45,214 $97,141

Southwest $46,709 $50,838 $44,638 $65,198 $84,545 $55,212

West $31,349 $22,909 $36,023 $67,786 $46,806 $70,063

NATION $40,092 $35,666 $41,474 $87,742 $64,271 $82,482

1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

NOTE: Regarding Medicare reimbursement, hospitals and physicians' offices use the same billing codes, but rates differ. Medication charges incurred in a physician's office are usually paid at contracted rates, which can be lower than billed charges. Hospitals generally pay less for chemotherapy and are reimbursed at lower rates, but receive fees that include average sales price (ASP) + 6% in the physician office setting. Separately paid drugs in hospital outpatient departments are expected to be reimbursed at ASP + 4% in 2013.

• Physician office claim charges include only those drug charges administered in the office setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with physician office administrative service charges.

• Hospital outpatient charges incorporate all aspects of care, including direct (i.e., pharmacy, imaging, administrative provider services) and indirect (i.e., financial services, information technology, operations expenses) overhead.

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Practice and Hospital Site of Service Costs

Site of Service Case Study for Florida

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Percentage of Florida Cancer Patients, by Age Group, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

TUMOR TYPE 0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Colorectal Cancer 4.0% 29.7% 33.8% 27.4% 4.9% 8.2% 51.8% 22.3% 13.7% 3.7%

Prostate Cancer 0.2% 16.1% 37.9% 38.6% 7.0% 0.3% 28.3% 39.5% 24.4% 7.3%

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Percentage of Florida Cancer Patients, by Payer

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

Medicare Medicaid Commercial1 Medicare Medicaid Commercial1

TUMOR TYPE 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011 2010 2011

Colorectal Cancer 55.7% 58.3% 6.9% 7.7% 37.3% 33.8% 20.0% 18.4% 11.0% 11.5% 68.9% 70.0%

Prostate Cancer 66.4% 69.5% 2.5% 2.4% 31.0% 28.0% 26.2% 25.2% 3.8% 4.4% 69.8% 70.3%1 Includes HMOs, PPOs, point-of-service (POS) plans and exclusive provider organizations.

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Percentage of Florida Cancer Patients with Metastatic Cancer

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

TUMOR TYPE 2010 2011 2010 2011

Colorectal Cancer 24.9% 24.4% 31.2% 32.1%

Prostate Cancer 4.8% 5.4% 10.8% 11.2%

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Average Length of Therapy (Days) for Florida Cancer Patients, by Age Group, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

TUMOR TYPE 0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Colorectal Cancer 122 159 183 181 143 197 150 166 167 131

Prostate Cancer — 190 172 168 181 — 105 127 163 61

NOTE: Some regimen metric data were unavailable for the selected regions.

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Annual Charges for Florida Cancer Patients, by Age Group, 2011

PHYSICIAN OFFICE HOSPITAL OUTPATIENT

TUMOR TYPE 0–45 46–64 65–74 75–84 85+ 0–45 46–64 65–74 75–84 85+

Colorectal Cancer $50,981 $53,714 $44,461 $36,376 $36,576 $126,496 $96,935 $97,293 86,276 $48,532

Prostate Cancer — $41,541 $50,540 $29,906 $13,375 — $68,666 $99,061 $65,807 $36,327

NOTE: Regarding Medicare reimbursement, hospitals and physicians' offices use the same billing codes, but rates differ. Medication charges incurred in a physician's office are usually paid at contracted rates, which can be lower than billed charges. Hospitals generally pay less for chemotherapy and are reimbursed at lower rates, but receive fees that include average sales price (ASP) + 6% in the physician office setting. Separately paid drugs in hospital outpatient departments are expected to be reimbursed at ASP + 4% in 2013.

• Physician office claim charges include only those drug charges administered in the office setting (i.e., chemotherapy, supportive care, steroids). If there is a lab component, this would also be captured, along with physician office administrative service charges.

• Hospital outpatient charges incorporate all aspects of care, including direct (i.e., pharmacy, imaging, administrative provider services) and indirect (i.e., financial services, information technology, operations expenses) overhead.

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Practice and Hospital Site of Service Costs, for Prostate Cancer, by Specialty

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Percentage of Prostate Cancer Patients, by Specialty, Physician Office Setting, 20111

SPECIALTY

REGION Oncology Urology Other2

Central 5.4% 92.4% 2.1%

Northeast 5.9% 91.6% 2.3%

Southeast 6.8% 90.5% 2.5%

Southwest 10.0% 81.7% 8.1%

West 12.6% 80.7% 6.6%

NATION 7.7% 88.3% 3.9%

1 Specialty data were available for the physician office setting only.2 “Other” includes internal medicine, radiation oncology, family medicine, geriatric medicine and others.

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Length of Therapy and Number of Cycles, by Specialty, Prostate Cancer, Physician Office Setting, 20111

ONCOLOGY UROLOGY

REGION Length of Therapy

Number of Cycles

Length of Therapy

Number of Cycles

Central 197 6 135 4

Northeast 169 6 182 4

Southeast 181 6 162 4

Southwest 190 6 142 4

West 168 5 161 4

NATION 181 6 158 4

1 Specialty data were available for the physician office setting only.

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Length of Therapy and Number of Cycles, by Specialty, Metastatic Prostate Cancer, Physician Office Setting, 20111

ONCOLOGY UROLOGY

REGION Length of Therapy

Number of Cycles

Length of Therapy

Number of Cycles

Central 205 6 125 5

Northeast 165 6 160 5

Southeast 186 6 155 5

Southwest 190 6 131 5

West 166 6 109 5

NATION 185 6 137 5

1 Specialty data were available for the physician office setting only.

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Average Annual Charges, by Specialty, Metastatic Prostate Cancer, Physician Office Setting, 20111

SPECIALTY

REGION Oncology Urology All Specialties

Central $35,607 $61,309 $41,190

Northeast $39,820 $59,047 $44,016

Southeast $54,050 $62,585 $55,845

Southwest $52,916 $57,209 $53,133

West $40,098 $43,095 $40,097

NATION $45,516 $57,092 $47,444

1 Specialty data were available for the physician office setting only.

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