Medicare’s payment system for cancer care services should be restructured to focus on value over volume and offer incentives for providing high-quality, patient-centered care, according to a new proposal from the American Society of Clinical Oncology (ASCO).
here’s the release
The American Society of Clinical Oncology (ASCO) today released a detailed proposal for a new approach to physician payment for cancer care services under Medicare. ASCO’s model would fundamentally restructure the way oncologists are reimbursed for cancer care in the United States by focusing payment on the full range of patient services that oncologists provide, while incentivizing high-quality, patient-centered care.
The proposed payment system, Consolidated Payments for Oncology: Payment Reform to Support Patient-Centered Care for Cancer, was developed by oncologists who practice in community-based practices across the United States. The proposal, which aims to improve the quality of cancer care by focusing on the value rather than the volume of services provided, would reduce administrative costs for practices and payers and help sustain patient access to community oncology care by making Medicare reimbursement more stable and predictable.
This effort further advances the commitment jointly announced in January by ASCO and the Community Oncology Alliance to advance models of payment reform that can be adopted by both the Medicare program and private insurers. The goal of both organizations is to develop one model with different payment mechanisms that allow providers the flexibility to adopt those most effective for their practice environment. (An overview of the COA Medicare payment reform model can be viewed here.)
“The current Medicare physician payment system does not recognize cognitive-based services nor does it reimburse for critical patient support services that practices provide such as nutritional guidance and symptom management. At the same time, soaring healthcare costs are creating untenable instability in the cancer community,” said ASCO President-elect Peter P. Yu, MD, FASCO. “Today’s system should be replaced with payment approaches that drive high-quality care and put patient access to care first. We offer this approach as one reasonable alternative that reflects the current realities of oncology practice and helps ensure patients receive the full range of services that are integral to high-quality care.”
The innovative payment approach, developed by the ASCO Payment Reform Workgroup, moves away from the current fee-for-service system, and instead structures physician payments around five types of flexible “bundles” that reflect care provided for patients at different stages of treatment. (See www.asco.org/paymentreform for detailed descriptions of these payments.)
Anticipating uncertainties that are inherent in transitioning to any new payment model, the ASCO proposal limits risk to practices in the early phases of implementation.
In addition, the ASCO proposal promises to strengthen cancer care and improve practice stability in several key ways:
Support for coordinated, patient-centered care. The new ASCO payment model would complement other payment reforms that support primary care medical homes and accountable care organizations by giving medical oncologists the flexibility and resources they need to deliver the highest-quality oncology care to patients with cancer at an affordable cost.
Simpler billing structure. The model significantly reduces administrative burdens on oncology practices and simplifies cost-sharing for patients by streamlining the number of billing codes required under the current system, from 58 to 11, better matching the types and costs of services delivered and covering the full range of services provided.
More predictable practice revenues. The proposed payment structure would provide more predictable monthly revenues so that an oncology practice can sustain the services patients need. Additionally, practice revenues would be less dependent on infusion chemotherapy drugs as they are today, thereby reducing the financial penalties practices now face if patients are treated with oral chemotherapy.
Accountability for delivering high-quality, evidence-based, patient-centered care. Practices that deliver higher quality care that meets national standards would be rewarded with up to 10 percent higher payments. To ensure appropriate levels of care are administered, the amount of payment each oncology practice receives would be decreased by up to 10 percent if recommended care is not provided, if the quality of care is lower than what other oncology practices routinely deliver, or if patients experience preventable complications.
In releasing Consolidated Payments for Oncology: Payment Reform to Support Patient-Centered Care for Cancer, ASCO calls on Congress and the Administration to seriously consider the society’s proposal as a potential model for oncology as it moves forward on Medicare reform.
“As the physicians who deliver cancer care in this country, we are in a unique position to substantively contribute to the national discussion on the future of the Medicare,” said Jeffery Ward, MD, chair of the ASCO Payment Reform Workgroup. “We look forward to working in partnership with policymakers to shape a system that puts the patient at the center of care and is viable to oncology practices.”
According to ASCO, this model will simplify operations for most oncology practices, but the society envisions an approach to payment reform whereby practices are able to choose from a number of different approaches best-suited to individual practice needs and requirements. “Given the variability in oncology practice size, location, and patient population, we don’t believe a one-size-fits-all system makes sense in this country,” said Dr. Ward.
The ASCO Payment Reform Workgroup, comprised of leading oncologists who practice in community- and hospital-based practices, developed the proposed payment system under the guidance and leadership of ASCO’s Board of Directors. The proposal is based on initial modeling, with actual payment levels to be set after further piloting by oncology practices of all sizes and demographics across the United States. “We believe we have identified the essential elements of what a patient-centered, oncology-specific payment system should look like,” said Dr. Ward. “Additional piloting by oncology practices will help identify specific strengths and weaknesses in our proposal to guide further refinements going forward.”
ASCO plans to conduct extensive outreach about its proposed physician payment system to members and the larger oncology community. “We encourage every oncologist in this country to review and provide feedback on our proposal,” said ASCO President-Elect Dr. Yu. “Each one of us has a vitally important responsibility to help shape future cancer care in America, and this effort plays a key role.”