The American Society of Clinical Oncology earlier this month released an idea for a new payment system—Consolidated Payments for Oncology Care, or CPOC—and you need to learn about it if you care about how you get paid.
In the document—available as a pdf at http://bit.ly/1kGIkkb—ASCO advocates scrapping the current system for a bundled payment approach to cancer care:
- New patient payment: This would be much larger than what practices receive initial office visits today and would pay for developing treatment plans and doing patient education and counseling.
- Treatment month payment: This would replace current payments for evaluation and management and infusion services. The payment would occur during each month the patient is being treated, regardless of the type of drugs used. Bigger payments would be made for patients with multiple health problems, poor performance status, and the need for more toxic and complex drug regimens. Reimbursement for drug costs would remain separate.
- Active monitoring month payment: This payment applies during months when a patient is not being actively treated but is still receiving support from the practice such as testing and monitoring for recurrences or progression of cancer.
- Transition of treatment payment: This additional payment during months when a patient's disease progressed or recurred or when significant treatment regimen changes are needed would reflect the extra time needed for treatment planning and patient education.
- Clinical trial payment: An additional monthly payment would be made for each patient participating in a clinical trial.
In addition to the five bundled payments, the practice would receive separate payments for tests and major procedures and reimbursement for drugs the practice purchases for administration in the office.
These are the details we have been waiting for since ASCO and the Community Oncology Alliance (COA) released their joint principles for payment reform earlier this year (http://bit.ly/1omikhM). COA's model for payment reform (pdf available at http://bit.ly/1hueIW9) differs from ASCO's in some significant ways.
In a Q&A document (http://bit.ly/1imy7Ii), ASCO says it intends to suggest dollar figures for each of the payment bundles to Medicare. If your top Q is how this will affect your practice financially, here's what ASCO says: “CPOC will help oncology practices avoid losing revenue if they redesign care based on an interdisciplinary team approach and use alternative ways for physicians to interact with patients other than face-to-face visits.”
And check out this four-page document to find out what the oncologists and practice managers who came up with this proposal are thinking: http://bit.ly/1sfvcs5.