Continuity of Medication Care for Cancer Patients Through Outpatient Service Provision in Specialist Practices in Germany

OBJECTIVES: Continuity and patient-centeredness are particularly important in the medication-based care of cancer patients. Routine process data is required to evaluate the services provided. Yet the analysis of drug prescriptions from health insurance data is dependent on data availability and prone to distortion. This raises the question of how physician reimbursement data can contribute to overcoming these limitations.

METHODS: Over a period of 20 years, physician reimbursement data was analyzed, to investigate the extent of oncological treatment continuity in Germany. These so-called EBM codes are transmitted quarterly to the associations of statutory health insurance physicians (KV). From 2005 to 2020, data from every 3rd remuneration quarter per year and, since Q1/2021, data from every remuneration quarter of office-based hematologist-oncologists from all KV regions in Germany were analyzed. All EBM codes (in brackets) applicable under the Oncology Agreement were included in the analysis, with a focus on the reimbursement codes for intracavitary (86514, 96502), intravascular (86516, 96503) and oral (86520, 96505) drug-based tumor therapy.

RESULTS: A maximum of n=153 hematology-oncology practices in Germany provided data on the care of up to n=161,488 cancer patients per quarter. The newly introduced billability of drug-related cancer treatments under the Oncology Agreement in 2019 resulted in a tenfold increase in these billing codes in outpatient reimbursement records between 2018 and 2019. In 2020, a plateau was reached, which was maintained even during the SARS-CoV-2 pandemic in 2021 (average of 1.072-1.231 reimbursement codes per quarter per patient for drug-based tumor therapy) and has continued to increase since Q4/2021.

CONCLUSIONS: Physician reimbursement data can be used to map the healthcare provision in hematology-oncology outpatient practices over time. This German-wide analysis shows a stable medication supply situation for cancer patients in the ambulatory setting over the 20-year-observation period, even during the SARS-CoV-2 pandemic.