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Practice Matters
News from Lola Butcher about health policy and practice management issues of importance to oncologists
Monday, February 17, 2014
How to Pay for Cancer Care

Cancer care providers -- and payers -- agree that a new way for paying for cancer treatment and follow-up monitoring must be found, but exactly what that new pay system should be remains unclear.


The American Society of Clinical Oncology and the Community Oncology Alliance are advancing the discussion by jointly issuing a set of payment reform principles. They agree with everyone else that Medicare’s current system -- paying the average sales price for cancer drugs plus six percent -- is insufficient to cover the costs of most oncology practices and it does nothing to differentiate between physicians who provide high-quality care and those who do not.


The joint principles include:

·    Oncology professionals should take a lead in developing new care models, which must promote access to evidence-based care, improve quality, and help control costs.

·    Changing to new care models requires significant expense, time, and effort so changes in payment models should be incremental over a period of time. Oncology providers should be protected against new pay policies that will undermine their ability to invest in their practice changes.

·    Quality measures should play an important role in evaluating and paying oncology providers.

·    One-size-fits-all may not apply to oncology delivery or pay models. Rather, providers should be able to choose the approach that fits best in their community.


Indeed, ASCO and COA each has its own proposal for cancer care payment reform.


ASCO wants to see monthly payments for cancer care in which the payment amount reflects the particular stage of care, such as treatment, non-treatment and transition of treatment. Additionally, ASCO proposes additional compensation for performance on quality measures, adherence to cancer care pathways, management of patient care that reduces emergency and inpatient care, and participation in clinical trials.


Meanwhile, COA is promoting a pay system that would support its Oncology Medical Home practice model. Its concept, which would be phased in over five years, would gradually replace fee-for-service with episode-of-care payment and shared savings that reward clinicians for high- quality care delivered at the lowest possible cost.


I want to hear from you. Do either of these proposals sound feasible? Please tweet me at @lolabutcher or leave a comment here.

Dr. John Sheldon said:
Time-driven activity based costing is an approach with great merit. MDACC is exploring this. See good article/section in Wall Street Journal from 02/24/13 on health care costs.
Dr. ray drasga MD said:
In January, Dr. Lawrence Einhorn and I had an article in the Journal of Oncology Practice in which we urge our fellow oncologists and ASCO to endorse a more fundamental solution to the problem of paying for cancer care -- i.e. to support a system of single-payer national health insurance. We're pleased to report that the article is provoking a lively and welcome discussion. Readers may want to consider our arguments and the evidence we marshal to support them. It's clear we need to tackle the problems head on, and comprehensively. Piecemeal reforms, while perhaps helpful here and there, are insufficient to address the magnitude of the problems facing our patients and our profession. Ray Drasga MD http://jop.ascopubs.org/content/10/1/7.full
About the Author

Lola Butcher
LOLA BUTCHER, MPA, MA, an award-winning Contributing Writer for Oncology Times, writes about health policy and business trends. She is a frequent contributor to Hospitals & Health Networks, Modern Physician, Neurology Today, and other health care trade publications. This blog was recently recognized with an APEX Award for Publication Excellence.