Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Two policy strategies have been pursued to moderate spending on infused cancer biologics. The competition strategy seeks to stimulate market entry by biosimilars, under the principle that newer entrants will charge lower prices than current branded products and that branded products will offer price reductions to slow the loss of their market share. The site-neutral payment strategy seeks to reduce insurers' reimbursements to hospitals to the levels paid to physician practices, instead of having prices be determined by the hospitals' and physicians' relative market power. This study compared the potential savings from full implementation of the biosimilars competition and site-neutral payment strategies, respectively. Deidentified claims data for 2020-22 were obtained from national Blue Cross Blue Shield plans on 43,643 patients who incurred 429,517 infusion visits for cancer biologics and biosimilars. Across the three years covered by this study, potential savings from site-neutral payment ($1.004 billion) were double those from biosimilars competition ($0.465 billion).
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1377/hlthaff.2024.01549 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Physician Practice Affiliation Drives Site of Care Cost Differentials: An Opportunity to Reduce Healthcare Expenditures.
J Mark Access Health Policy
September 2025
Arizona Digestive Health, Phoenix, AZ 85037, USA;
The continued migration of physicians from independent practice to affiliation with larger entities has garnered significant scrutiny. These affiliation models include hospitals and health systems, payers and corporate entities, and management services organizations, which may or may not be private equity (PE)-backed. Data on the impact of different physician affiliation models on cost of care is limited.
View Article and Find Full Text PDFSite-Neutral Payment And Biosimilars Competition Are Complementary Purchaser Strategies For Cancer Biologics.
Health Aff (Millwood)
June 2025
Christopher M. Whaley, Brown University, Providence, Rhode Island.
Two policy strategies have been pursued to moderate spending on infused cancer biologics. The competition strategy seeks to stimulate market entry by biosimilars, under the principle that newer entrants will charge lower prices than current branded products and that branded products will offer price reductions to slow the loss of their market share. The site-neutral payment strategy seeks to reduce insurers' reimbursements to hospitals to the levels paid to physician practices, instead of having prices be determined by the hospitals' and physicians' relative market power.
View Article and Find Full Text PDFMedicare Site-Neutral Payment Policies: Effects Of Proposals On Hospitals And Beneficiary Groups.
Health Aff (Millwood)
June 2025
Melinda B. Buntin Johns Hopkins University.
Medicare pays hospital outpatient departments higher rates than ambulatory surgical centers and physician offices for providing similar health services. Policy makers are considering aligning payments across sites of care, but concerns have arisen about the potential disproportionate impacts of "site-neutral" payments on vulnerable providers and beneficiaries. We assessed the effects of three policy options on types of hospitals and beneficiaries.
View Article and Find Full Text PDFDid Site-Neutral Payment for Long-Term Care Hospitals Reduce Financial Incentives to Time Discharge?
J Am Med Dir Assoc
August 2025
Division of Hospital Medicine, UCSF at San Francisco General Hospital, San Francisco, CA, USA; School of Medicine, UCSF Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
Objectives: Historically, fee-for-service Medicare reimbursed long-term care hospital (LTCH) stays as a lump-sum payment, which was substantially reduced for discharges before the diagnosis-specific short-stay outlier (SSO) threshold day, leading to large spikes in discharges on the threshold day. The objective of this study was to examine if LTCHs similarly time discharge at the SSO threshold for blended site-neutral payment cases compared with standard payment cases.
Design: Cross sectional.
Site-Neutral Payment Reform: Little Impact On Outpatient Medicare Spending Or Hospital-Physician Integration.
Health Aff (Millwood)
June 2025
Gary J. Young, Northeastern University.
Medicare pays hospital outpatient departments higher rates than physician-owned practices, leading to higher spending and incentivizing hospitals to acquire physician practices. The Bipartisan Budget Act of 2015 introduced site-neutral payments for new outpatient departments but excepted existing ones. To evaluate the impact of this law, we analyzed 2013-20 Medicare claims data, comparing spending under site-neutral rates with spending under site-based rates and using difference-in-differences analysis to assess the effect on hospital-physician integration.
View Article and Find Full Text PDF