The Impact of Computerized Clinical Reminders on Physician Prescribing Behavior: Evidence From Community Oncology Practice

274 Background: The 2013 Community Oncology Practice Impact Report notes an increase of 20% in the number of community clinics closing since 2011. The objective of this study was to examine trends in location and reimbursement of chemotherapy in office-based (OBS) and outpatient hospital settings (OHS). Methods: Using the MarketScan Research Databases, first administrations of bevacizumab and trastuzumab were identified from 1/1/2005 through 12/31/2012 for patients with commercial or employer-sponsored supplemental Medicare insurance. Bevacizumab claims were excluded if the claim had a diagnosis related to macular degeneration or other eye disease. Claims for both drugs were excluded if the reimbursed amount was less than $100. Chemotherapy administration reimbursements were identified through CPT codes on the same day as the day as the drug charge. All claims were identified as occurring in OB or OHS. Results: The percent of bevacizumab claims occurring in OHS increased from 6 to 34% among Medicare claims, and from 15 to 42% among commercial claims from 2005 to 2012. For trastuzumab, the increases were 4 to 35%, and 10 to 35% in Medicare and commercial claims, respectively. OHS reimbursements were consistently higher than OBS reimbursements for chemotherapy administration and drug for both drugs across both payers. Conclusions: Although the differential in reimbursements between OHS and OBS declined in the most recent two years, OHS reimbursements remained substantially higher while the shift in chemotherapy administration from OBS to OHS has continued through 2012. Continued attention to reimbursement differences between OHS and OBS is warranted and additional research is needed to more fully document the impact on patients, providers, and payers. [Table: see text]

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Changing Physician Prescribing Behavior: A Low-Cost Administrative Policy That Reduced the Use of Brand Name Nonsteroidal Anti-inflammatory Drugs

Preventive Medicine ◽

10.1006/pmed.1996.0105 ◽

1996 ◽

Vol 25 (6) ◽

pp. 668-672 ◽

Cited By ~ 10

Author(s):

Jasjit S. Ahluwalia ◽

Montie L. Weisenberger ◽

Annette M. Bernard ◽

Sally E. McNagny

Keyword(s):

Low Cost ◽

Brand Name ◽

Prescribing Behavior ◽

Administrative Policy ◽

Inflammatory Drugs ◽

Physician Prescribing Behavior ◽

Anti Inflammatory ◽

Physician Prescribing

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Impact of a central review oncology clinical pharmacist in a community oncology practice.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.68 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 68-68

Author(s):

Julianna Kula ◽

Shannon Hough ◽

Josh Howell

Keyword(s):

Clinical Pharmacist ◽

Cost Effective ◽

Cost Of Care ◽

Financial Impact ◽

Full Time ◽

Community Oncology ◽

Medication Dose ◽

Oncology Practice ◽

Clinical Changes ◽

The Impact

68 Background: The impact and role of a clinical pharmacist in a community oncology setting is not well-described in the literature. The US Oncology Network recently implemented a central clinical pharmacist review program (ClinReview) to offer oncology remote clinical pharmacist services to practices. Methods: An oncology-trained clinical pharmacist electronically reviewed recently placed or modified chemotherapy regimen orders within a community oncology practice. The ClinReview pharmacist identified opportunities to modify ordered therapy based on clinical components, waste reduction, or financial stewardship. Recommendations were discussed with the treating oncologist at the practice or modified if permitted by approved practice policy. The pharmacist was appointed at 0.5 full-time equivalents (FTE). Financial and workload metrics were tracked to monitor the impact of the pharmacist work. Results: In 10 weeks, 388 reviews were documented and 191 (49.2%) required a modification by the pharmacist. Recommended modifications included dose rounding (n=90, 47%), a clinical change (n=72, 38%), or product substitution (n=29, 15%). The most common clinical changes included modifications to supportive care (n=32, 44%), recommendations for additional monitoring (n=19, 26%), or modifications to anti-cancer medication dose or frequency (n=18, 25%). The financial impact of the pharmacist resulted in margin improvements totaling $106,043 and a $462,305 reduction in the total cost of care in medication expenses (Table). The expense of the pharmacist during this period was $18,095. The return on investment for the pharmacist compared to margin improvement was 590%. Conclusions: An oncology clinical pharmacist is a cost-effective and valuable member of the care team in community oncology practice. The pharmacist identified opportunities to improve medication safety, regimen optimization, and demonstrated significant financial impact for the practice, payers, and patients.[Table: see text]

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