Variation and cost in oncology care represent a large and growing burden for the US health care system. In 2010, the cost of oncology care was estimated at nearly $125 billon; by 2020, this is projected to reach almost $160 billion. Significant regional variation in per capita spending on health care has been noted; higher spending is not associated with higher quality and has thus been identified as a marker of inefficient and low-quality care

Acute care utilization is the single largest driver of regional spending variation in oncology care, accounting for 48% of spending and 67% of variation.4 A proposed Centers for Medicare and Medicaid Service (CMS) rule seeks to reduce this variation. The rule, OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy, is meant to assess the quality of care for patients receiving chemotherapy and encourage performance improvement; if finalized, it will affect hospitals’ outpatient Medicare payments beginning in 2020.

There are three primary measures of acute care for patients with cancer: emergency department (ED) visits, acute hospitalizations, and 30-day rehospitalizations. Patients with cancer visit the ED most often because of fever, pain, dehydration, abdominal complaints, and respiratory concerns.