All ETDs from UAB

Advisory Committee Chair

Meredith L Kilgore

Advisory Committee Members

Carla I Falkson

Marie A Bakitas

Rodney O Tucker

Robert Weech-Maldonado

Document Type

Dissertation

Date of Award

2016

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

Reimbursement for chemotherapy could account for two thirds of the income for oncologists in private practice. The Medicare prescription drug improvement and modernization act of 2003 (MMA) brought about a dramatic change in the way physicians were reimbursed for delivering chemotherapy in an attempt to slow the skyrocketing costs of drugs and Medicare costs for covering these drugs . The MMA reduced Medicare reimbursements for covered outpatient prescription drugs from 95% to 85% of the average wholesale price. In 2005, a new payment system was instituted that reimbursed fee-for-service providers for drugs at the national average sales price plus 6%. Aggressive treatment at end of life in the oncology population does not improve quality of life and during the 1990’s a crisis was identified in end of life care in the U.S. Timely cessation of chemotherapy treatment and timely referral to hospice are two quality indicators which have been validated to be identified from insurance claims to measure quality end of life care. The study aims to study the quality of end of life care received by Medicare beneficiaries who died in the period 1999-2010 with a primary or secondary diagnosis of cancer, using the two abovementioned validated quality indicators.

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