Financial Impact and Safety Considerations of Outpatient Versus Inpatient Chemotherapy Mobilization in Autologous Stem Cell Transplantation

Abstract

Rising costs to treat hematologic cancers are problematic for patients as well as institutions. Reimbursement rates are down and inpatient volumes are high. In searching for ways to decrease costs and increase bed availability, while maintaining patient safety and standard of care, our program instilled a plan to move all chemotherapy mobilization to the outpatient setting. The goal of this project is to establish an outpatient chemotherapy mobilization regimen that is cost effective and a safe option compared with inpatient chemotherapy mobilization. A multidisciplinary transplant team collaborated to define the safest, most cost effective manner to administer chemotherapy mobilization in the outpatient setting for our patient population. The move to outpatient mobilization became effective October 2013. The data will be reviewed from January 2010 until June 2015 to report complications and the charge of mobilization both inpatient and outpatient. The plan is to identify any issues that were identified during this time frame and implement changes to the mobilization pathway. Until October 2013, patients could choose between inpatient and outpatient mobilization. Because the Center for Medicare and Medicaid Services (CMS) started decreasing payment and/or denying inpatient mobilization, our center evaluated other ways to provide safe, cost effective mobilization. Data was collected on autologous stem cell transplant patients to evaluate the charges of inpatient versus outpatient mobilization. The side effects/complications which occurred were included in the data analysis. Patients doing inpatient mobilization complained of more side effects and had more transfusions than outpatient mobilizers. Patient safety was not compromised with moving mobilization to the outpatient setting, as evidenced by fewer complications. After analyzing charges, it was found to have fewer charges to do outpatient mobilization, but was cost effective. The data is affected by the rising cost of drugs and general healthcare costs. Comparing 19 transplants in 2014 to the same in 2012, there was a 149% increase in charges for the same service. The goal of moving mobilization to the outpatient setting was achieved safely for the patients and has improved insurance reimbursement for outpatient mobilization.