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Hospital Charges For Outpatient Cancer Care Highly Variable, Medicare Billing Records Show

An analysis of recent Medicare billing records for more than 3,000 hospitals across the United States shows that charges for outpatient oncology services such as chemo infusion or radiation treatment vary widely and exceed what Medicare will pay by twofold to sixfold. A report of the findings, published in the American Journal of Managed Care on Feb. 17, emphasizes the need for fair and transparent pricing of cancer-related medical services to protect patients from unpredictable financial burdens at a time when they are most vulnerable, according to researchers from the John Hopkins School of Medicine who conducted the analysis.

For the study, researchers obtained all Medicare billing records for 3,428 hospitals from all 50 states in 2014 to determine how much hospitals and their various departments that offer cancer-related outpatient services billed for services compared with the Medicare allowable amount, which is the set amount Medicare will pay for a specific service. Using the American Hospital Association database, the research team identified size, nonprofit status, rural location and academic status for each hospital whose billing data were made part of the analysis. The researchers also identified a subgroup of prestigious hospitals listed among the 2014 U.S. News & World Report’s Best Hospitals Honor Roll.

For each oncology specialty service within a hospital, the researchers calculated a markup ratio, defined as the ratio of the billed charges relative to the Medicare allowable amount. For example, a markup ratio of 4.0 means that for a service with a Medicare allowable amount of $1,000, the hospital charged $4,000, or 300 percent over the Medicare allowable amount. Services included lab tests, PET scans, and chemo infusion and radiation services.  The research team found that of the 3,428 hospitals, specialty departments charged anywhere from a middle range of 2.4 to 4.1 times more than what Medicare paid for those services.

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