Medicare

GAO has previously reported that oncologists have admitted sending patients to hospitals to avoid reimbursement problems associated with treating patients in their offices. In this report, GAO discusses the factors that influence where oncologists treat Medicare patients and the potential cost to the government of treatment in different settings. Some oncologists have treated cancer patients in hospital inpatient and outpatient settings when, by clinical standards, they could have received treatment in the office. Financial factors influenced the oncologist's choice of setting, suggesting that the Health Care Financing Administration's reimbursement policies can have consequences beyond their intent. That is, whether and how much doctors are reimbursed by Medicare can influence the oncologist's choice of treatment setting and, as a result, can escalate Medicare expenditures.

GAO found that: (1) some oncologists have treated cancer patients in hospital inpatient and outpatient settings when, by clinical standards, these patients could have received treatment in the office; (2) oncologists interviewed consistently stated that their choice of treatment setting was influenced by whether they expected reimbursement to be adequate if they provided treatment in the office setting; and (3) treatment in the hospital inpatient setting was more expensive to Medicare than hospital outpatient or office treatment settings.