title: Physician behavior impact when revenue shifted from drugs to services.
abstract: OBJECTIVE
  In partnership with a large nonprofit healthcare insurer for the Mid-Atlantic region of the United States, we launched the first cancer clinical pathway in the United States in August 2008. Due to its early success with regard to savings and physician participation and compliance, a second-generation pathways program-the Oncology Medical Home-was piloted in 2011. This program offered a physician reimbursement model that shifted the source of revenue from drug reimbursement margin to professional charges for cognitive services (evaluation and management codes). We report our observations of the impact of that reimbursement model on physician prescribing behavior.
  
  
  METHODS
  This was a retrospective analysis.
  
  
  METHODS
  A select group of practices that participated in the first-generation pathways program were invited to voluntarily participate in the Oncology Medical Home and its cognitive weighted reimbursement design. A matched control group was chosen from the first-generation pathways participants. Comparisons of physician behavior parameters were made pre- and postimplementation and between the Oncology Medical Home practices and the first-generation pathways control group.
  
  
  RESULTS
  Physician behavior was not significantly modified by cognitive weighted reimbursement. No significant change in frequency of office visits for established patients was observed. No change in chemotherapy prescribing was observed. Observed increases in generic regimen use were no different than matched control.
  
  
  CONCLUSIONS
  Observations from this oncology medical home pilot program suggest that reimbursement methodology alternatives to the prevailing fee-for-service may have less impact on prescribing behavior than has been conjectured. Future research is ongoing to validate these observations and assess additional influences on prescribing behavior.
authors.affiliation: 7000 Cardinal Pl, Dublin, OH 43017. E-mail: bruce.feinberg@cardinalhealth.com.
authors.forename: Bruce
authors.initials: B
authors.lastname: Feinberg
authors.forename: Scott
authors.initials: S
authors.lastname: Milligan
authors.forename: Tim
authors.initials: T
authors.lastname: Olson
authors.forename: Winston
authors.initials: W
authors.lastname: Wong
authors.forename: Daniel
authors.initials: D
authors.lastname: Winn
authors.forename: Ram
authors.initials: R
authors.lastname: Trehan
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Scott
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics; D001291:Attitude of Health Personnel; D002173:Cancer Care Facilities / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000191:economics* / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000191:economics / Q000458:organization & administration; D018802:Patient-Centered Care / Q000191:economics* / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000458:organization & administration; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D014481:United States
chemical_list: D000970:Antineoplastic Agents