An op-ed piece in The New York Times by oncologist Ezekiel Emanuel, MD, is a must-read for anyone who worries that cancer care is getting too expensive to be sustainable.
Emanuel is a regular in the Times Review section, and the commentary, “A Plan to Fix Health Care” (NY Times, posted 3/23/13) appears under his byline. But, very importantly, more than 20 cancer care leaders helped draft the essay, showing a consensus about the direction that needs to be pursued.
These include Lowell Schnipper, MD, Chief of Hematology/Oncology at Beth Israel Deaconess Medical Center and Chair of ASCO's Cost of Cancer Care Task Force; John Sprandio, MD, a leader in the oncology medical home movement; Lee Newcomer, MD, Senior Vice President-Oncology for UnitedHealth Group; and many others I have interviewed for OT.
They use the essay as a call to action for the Medicare program and other payers to work with oncologists to change payment and policies to save America's cancer care system. Emanuel et al recommend five components of a solution and a timeline for implementation.
“The Secretary of Health and Human Services should organize a working group representing Medicare, private insurers, oncologists, quality experts, and patients to figure out how to develop these proposals—with no increase in costs—and start implementing them by the end of 2015,” the writers said. “Everyone engaged in cancer care needs to help improve it.”
The changes they call for:
- A move to bundled payments in which oncologists are paid a single fee for all the treatments involved in a patient's cancer care.
- Information from insurers to physicians about where money is being spent. Physicians know this, but most other people don't: “As crazy as it sounds, most physicians have little ability to track the care they deliver, or how they compare with other physicians who care for similar patients,” Emanuel and his colleagues write.
- Quality monitoring to ensure that new payment methods do not incentivize under- and over-utilization of care.
- More “high touch” oncology practices, including nurse management of common symptoms to avoid emergency and inpatient care and better palliative care and end-of-life planning.
- Better incentives for research to reduce the use of tests and treatments that add costs without improving patient outcomes.