{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:40:02Z","timestamp":1789555202188,"version":"build-2803163510"},"reference-count":56,"publisher":"BMJ","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2025,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate the association between the billing (profit) margin and clinical benefit of cancer treatments and use by oncologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective population based cohort study<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Population based sample using fee-for-service Medicare claims data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Medicare beneficiaries with an incident cancer diagnosis from 2015 to 2020; included all patients with cancer treatment indications for which the available treatment options varied in clinical benefit and billing margin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcomes and measures<\/jats:title>\n                    <jats:p>The primary outcome was the cancer treatment each patient received among treatment options recommended by the National Comprehensive Cancer Network (NCCN). The characteristics of interest were provider billing margin (defined at the patient treatment level, using Medicare reimbursement rates corresponding to the patient\u2019s diagnosis date) and a proxy measure of clinical benefit (rank order of treatments based on Evidence Blocks scores developed by the NCCN, corresponding to the patient\u2019s diagnosis date). The association between treatment received, billing margin, and clinical benefit was modeled using a conditional logit model with inverse probability-of-treatment weights applied at the patient treatment level to control for patient and provider characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve cancer indications were examined comprising 19\u2009397 individual patients. Provider billing margin ranged from $0 to $12\u2009692 (\u00a39440; \u20ac10\u2009800) for each course of treatment. No association was found between a $100 increase in provider billing margin and the likelihood of treatment use (odds ratio 0.97, 95% confidence interval 0.91 to 1.03). Higher clinical benefit was associated with greater treatment use (1.62, 1.15 to 2.29).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this observational study of Medicare beneficiaries, selection of cancer treatments was associated with the treatment\u2019s clinical benefit but not billing margin. Therefore, it is unlikely that policy and price changes that affect the billing margin of cancer treatments would shift patterns of use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2025-084729","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T15:45:16Z","timestamp":1762357516000},"page":"e084729","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Provider billing margin and cancer treatment selection: population based cohort study"],"prefix":"10.1136","volume":"391","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3639-3515","authenticated-orcid":false,"given":"Aaron P","family":"Mitchell","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"},{"name":"Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3907-9196","authenticated-orcid":false,"given":"Stacie B","family":"Dusetzina","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3477-5037","authenticated-orcid":false,"given":"Akriti","family":"Mishra Meza","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9277-5002","authenticated-orcid":false,"given":"Grace","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Augello","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2426-0096","authenticated-orcid":false,"given":"Hannah","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Guzman","sequence":"additional","affiliation":[{"name":"Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5039-4322","authenticated-orcid":false,"given":"Abdullah","family":"Abdelaziz","sequence":"additional","affiliation":[{"name":"University of Illinois Chicago, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5498-7176","authenticated-orcid":false,"given":"Sara","family":"Tabatabai","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5666-7994","authenticated-orcid":false,"given":"Sonia","family":"Persaud","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8104-4311","authenticated-orcid":false,"given":"Nirjhar","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1448-8671","authenticated-orcid":false,"given":"Victoria S","family":"Blinder","sequence":"additional","affiliation":[{"name":"Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1808-3070","authenticated-orcid":false,"given":"Andrew S","family":"Epstein","sequence":"additional","affiliation":[{"name":"Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6573-7650","authenticated-orcid":false,"given":"Bobby","family":"Daly","sequence":"additional","affiliation":[{"name":"Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2906-3913","authenticated-orcid":false,"given":"Aaron N","family":"Winn","sequence":"additional","affiliation":[{"name":"University of Illinois Chicago, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8683-8477","authenticated-orcid":false,"given":"Mithat","family":"G\u00f6nen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"2025110511251055000_391.nov05_5.e084729.1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-816072-5.00004-3"},{"key":"2025110511251055000_391.nov05_5.e084729.2","unstructured":"The Myth of Perverse Physician Incentives: Examining Research and Accusations in the Medicare Part B ASP Reimbursement System for Oncology. Published online 13 Dec 2018. Accessed 20 Nov 2024. https:\/\/communityoncology.org\/wp-content\/uploads\/2018\/12\/COA-Myth-of-Perverse-Incentives-Analysis-FINAL.pdf"},{"key":"2025110511251055000_391.nov05_5.e084729.3","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.437"},{"key":"2025110511251055000_391.nov05_5.e084729.4","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.00124"},{"key":"2025110511251055000_391.nov05_5.e084729.5","unstructured":"Horwitz J, Nikpay S, Blatteis J, Levick S, De Vos E, Nichols A. Research Note: Relative Profitability of Acute Care Hospital Services. 2nd ed. UCLA School of Law, 2021, https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=4065964, accessed 5 Dec 2024."},{"key":"2025110511251055000_391.nov05_5.e084729.6","doi-asserted-by":"publisher","DOI":"10.1007\/s40596-015-0480-0"},{"key":"2025110511251055000_391.nov05_5.e084729.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.p2038"},{"key":"2025110511251055000_391.nov05_5.e084729.8","unstructured":"Caffrey M. Part B Losses to Oncologists Due to IRA Could Total $12B Through 2032 Across Medicare, Commercial Plans. Community Oncology Alliance: News and Updates. 17 Sep 2025. Accessed 8 June 2025. https:\/\/www.ajmc.com\/view\/part-b-losses-to-oncologists-due-to-ira-could-total-12b-through-2032-across-medicare-commercial-plans"},{"key":"2025110511251055000_391.nov05_5.e084729.9","unstructured":"Vose J. Re: CMS-1670-P. Medicare Program; Part B Drug Payment Model. Published online 6 May 2016. Accessed 7 Oct 2024. https:\/\/www.regulations.gov\/comment\/CMS-2016-0036-1337"},{"key":"2025110511251055000_391.nov05_5.e084729.10","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2022.1022"},{"key":"2025110511251055000_391.nov05_5.e084729.11","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2021.6445"},{"key":"2025110511251055000_391.nov05_5.e084729.12","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-19-1534"},{"key":"2025110511251055000_391.nov05_5.e084729.13","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2012.000539"},{"key":"2025110511251055000_391.nov05_5.e084729.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1201141"},{"key":"2025110511251055000_391.nov05_5.e084729.15","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djv331"},{"key":"2025110511251055000_391.nov05_5.e084729.16","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.00133"},{"key":"2025110511251055000_391.nov05_5.e084729.17","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.1372"},{"key":"2025110511251055000_391.nov05_5.e084729.18","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.6196"},{"key":"2025110511251055000_391.nov05_5.e084729.19","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2015.3151"},{"key":"2025110511251055000_391.nov05_5.e084729.20","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.24.00459"},{"key":"2025110511251055000_391.nov05_5.e084729.21","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2017.23.6-a.s34"},{"key":"2025110511251055000_391.nov05_5.e084729.22","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2017.23.6-a.s13"},{"key":"2025110511251055000_391.nov05_5.e084729.23","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-020-00901-x"},{"key":"2025110511251055000_391.nov05_5.e084729.24","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2020.7574"},{"key":"2025110511251055000_391.nov05_5.e084729.25","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2024.42.16_suppl.11073"},{"key":"2025110511251055000_391.nov05_5.e084729.26","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2018-0423"},{"key":"2025110511251055000_391.nov05_5.e084729.27","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.0776"},{"key":"2025110511251055000_391.nov05_5.e084729.28","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.2765"},{"key":"2025110511251055000_391.nov05_5.e084729.29","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.67.4184"},{"key":"2025110511251055000_391.nov05_5.e084729.30","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3719"},{"key":"2025110511251055000_391.nov05_5.e084729.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2007.03.011"},{"key":"2025110511251055000_391.nov05_5.e084729.32","doi-asserted-by":"publisher","DOI":"10.2147\/POR.S197252"},{"key":"2025110511251055000_391.nov05_5.e084729.33","unstructured":"McFadden D. Conditional logit analysis of qualitative choice behavior. In: Frontiers in Econometrics. Academic Press, 1973: 105-42, https:\/\/eml.berkeley.edu\/reprints\/mcfadden\/zarembka.pdf, Accessed December 7, 2016."},{"key":"2025110511251055000_391.nov05_5.e084729.34","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.43.6063"},{"key":"2025110511251055000_391.nov05_5.e084729.35","doi-asserted-by":"publisher","DOI":"10.1007\/s10754-012-9117-y"},{"key":"2025110511251055000_391.nov05_5.e084729.36","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2009.0563"},{"key":"2025110511251055000_391.nov05_5.e084729.37","doi-asserted-by":"publisher","DOI":"10.14694\/EdBook_AM.2015.35.e75"},{"key":"2025110511251055000_391.nov05_5.e084729.38","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.18.00315"},{"key":"2025110511251055000_391.nov05_5.e084729.39","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djab196"},{"key":"2025110511251055000_391.nov05_5.e084729.40","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2019-0338"},{"key":"2025110511251055000_391.nov05_5.e084729.41","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000840"},{"key":"2025110511251055000_391.nov05_5.e084729.42","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2016.012930"},{"key":"2025110511251055000_391.nov05_5.e084729.43","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24448"},{"key":"2025110511251055000_391.nov05_5.e084729.44","doi-asserted-by":"publisher","DOI":"10.1002\/hec.3860"},{"key":"2025110511251055000_391.nov05_5.e084729.45","doi-asserted-by":"publisher","DOI":"10.1002\/hec.4909"},{"key":"2025110511251055000_391.nov05_5.e084729.46","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2008.0567"},{"key":"2025110511251055000_391.nov05_5.e084729.47","unstructured":"Nguyen N, Sheingold S. Medicare Part B Drugs: Trends in Spending and Utilization, 2006-2017. Assistant Secretary for Planning and Evaluation, Office of Health Policy; 2020. Accessed 10 May 2023. https:\/\/aspe.hhs.gov\/sites\/default\/files\/private\/pdf\/264416\/Part-B-Drugs-Trends-Issue-Brief.pdf"},{"key":"2025110511251055000_391.nov05_5.e084729.48","unstructured":"Report to the Congress: Medicare and the Health Care Delivery System. Chapter 5: Medicare Part B Drug and Oncology Payment Policy Issues. MedPac; 2016. Accessed 23 Nov 2017. https:\/\/www.medpac.gov\/docs\/default-source\/reports\/chapter-5-medicare-part-b-drug-and-oncology-payment-policy-issues-june-2016-report-.pdf?sfvrsn=0"},{"key":"2025110511251055000_391.nov05_5.e084729.49","unstructured":"Analysis: Oncologists Could Face Over $12 Billion Cut in Medicare and Commercial Part B Payments Due to IRA Negotiations. Published online 16 Sep 2024. Accessed 20 Nov 2024. https:\/\/mycoa.communityoncology.org\/news-updates\/press-releases\/analysis-oncologists-could-face-over-12-billion-cut-in-medicare-and-commercial-part-b-payments-due-to-ira-negotiations"},{"key":"2025110511251055000_391.nov05_5.e084729.50","doi-asserted-by":"publisher","DOI":"10.1093\/oncolo\/oyae035"},{"key":"2025110511251055000_391.nov05_5.e084729.51","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.34707"},{"key":"2025110511251055000_391.nov05_5.e084729.52","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.4868"},{"key":"2025110511251055000_391.nov05_5.e084729.53","doi-asserted-by":"publisher","DOI":"10.1200\/JCO-24-01907"},{"key":"2025110511251055000_391.nov05_5.e084729.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2023.09.029"},{"key":"2025110511251055000_391.nov05_5.e084729.55","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.12998"},{"key":"2025110511251055000_391.nov05_5.e084729.56","first-page":"SP156","article-title":"Observations regarding the average sales price reimbursement methodology","volume":"27","author":"Weidner","year":"2021","journal-title":"Am J Manag Care"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj-2025-084729","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj-2025-084729","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T19:25:18Z","timestamp":1762370718000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj-2025-084729"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,5]]},"references-count":56,"alternative-id":["10.1136\/bmj-2025-084729"],"URL":"https:\/\/doi.org\/10.1136\/bmj-2025-084729","relation":{},"ISSN":["1756-1833"],"issn-type":[{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,5]]}}}