Table 2.
Effect of MMA Reimbursement Change on Chemotherapy Receipt by Location of Administration in Medicare Beneficiaries Dying With Poor-Prognosis Cancer (2006 to 2007 v 2003 to 2004)
| Setting | Change in Probability of Receipt in Last: |
Change in No. of Treatments in Last:* |
||||
|---|---|---|---|---|---|---|
| 14 Days | 3 Months | 6 Months | 14 Days | 3 Months | 6 Months | |
| All patients | ||||||
| No. of patients | 57,656 | 57,656 | 182,426 | 8,602 | 44,203 | 57,656 |
| All settings | ||||||
| Mean (2003 to 2004) | 17% | 78% | 32% | 1.5 | 4.5 | 7.3 |
| Coefficient | −0.026† | −0.042† | −0.025† | −0.087 | −0.607† | −0.953† |
| SE | 0.008 | 0.012 | 0.005 | 0.050 | 0.098 | 0.164 |
| Physician office only | ||||||
| Mean (2003 to 2004) | 18% | 78% | 100% | 7.3 | 4.5 | 1.5 |
| Coefficient | −0.035† | −0.055† | −0.084 | −0.684† | −0.998† | |
| SE | 0.009 | 0.013 | 0.054 | 0.110 | 0.178 | |
| Outpatient department only | ||||||
| Mean (2003 to 2004) | 12% | 73% | 100% | 1.5 | 3.7 | 5.9 |
| Coefficient | 0.010 | 0.008 | −0.030 | 0.094 | −0.286 | |
| SE | 0.017 | 0.025 | 0.101 | 0.146 | 0.236 | |
| Physician office and outpatient department | ||||||
| Mean (2003 to 2004) | 20% | 89% | 100% | 1.6 | 6.0 | 10.9 |
| Coefficient | −0.024 | −0.004 | −0.113 | −0.979† | −1.131 | |
| SE | 0.035 | 0.030 | 0.260 | 0.372 | 0.671 | |
| Lung cancer cohort | ||||||
| No. of patients | 18,937 | 18,937 | 57,663 | 3,201 | 14,898 | 18,937 |
| All settings | ||||||
| Mean (2003 to 2004) | 19% | 80% | 33% | 1.5 | 4.8 | 7.8 |
| Coefficient | −0.014 | −0.046† | −0.023† | −0.038 | −0.877† | −1.373† |
| SE | 0.014 | 0.017 | 0.010 | 0.092 | 0.139 | 0.247 |
| Physician office only | ||||||
| Mean (2003 to 2004) | 20% | 81% | 100% | 1.5 | 4.8 | 7.9 |
| Coefficient | −0.007 | −0.051† | −0.004 | −0.948† | −1.389† | |
| SE | 0.017 | 0.019 | 0.108 | 0.164 | 0.272 | |
| Outpatient department only | ||||||
| Mean (2003 to 2004) | 15% | 74% | 100% | 1.5 | 4.1 | 6.2 |
| Coefficient | −0.047 | −0.022 | −0.201 | −0.173 | −0.806‡ | |
| SE | 0.034 | 0.036 | 0.227 | 0.273 | 0.399 | |
| Physician office and outpatient department | ||||||
| Mean (2003 to 2004) | 21% | 88% | 100% | 1.7 | 6.1 | 10.8 |
| Coefficient | −0.022 | −0.044 | 0.320 | −1.227 | −1.699 | |
| SE | 0.081 | 0.069 | 0.514 | 0.810 | 1.124 | |
NOTE. The all-settings group includes patients from each of the three mutually exclusive groups (ie, physician office only, outpatient department only, both). No. of patients applies to the all-settings group. Models control for patient demographics, comorbidities, cancer type, metastatic disease, and linear time trend. Heteroskedastic-robust SEs are clustered at the state level and pre-post time period.
Abbreviation: MMA, Medicare Modernization Act.
Beneficiaries were only included in No. of treatments model if they received chemotherapy in the specified time window.
Indicates significance at the 95% level.
Indicates significance at the 90% level.