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Cost Containment's Impact on Oncology Practices

Panelists:Michael Kolodziej, MD, Aetna; Andrew L. Pecora, MD, FACP, CPE, John Theurer Cancer Center; Jeffery C. Ward, MD, Swedish Cancer Institute
Published Online: Tuesday, Sep 29, 2015


Documentation associated with prior authorization and other cost-containment efforts places an administrative burden on oncologists, according to Jeffrey C. Ward, MD, who notes that he personally spends approximately 2 hours each day on such documentation. The result, he says, is less time for patient care.

Much of the burden is due to Medicare, not commercial payer requirements, since Medicare has a very complex claims-payment system, says Michael Kolodziej, MD. Both Medicare and commercial payers fall short in understanding what oncologists do, and thus apply sets of rules across the spectrum of healthcare that are not easily implemented in oncology, notes Kolodziej.

Prior authorization, which is designed to mitigate risk, is costly to both the oncology practice and the payer. There is still a need for oncologists to document that they are practicing evidence-based treatment, notes Kolodziej. However, this need will lessen as providers take on more risk. It is important that oncologists are held accountable for what they can control, not for what they cannot control, remarks Ward.

Payment reform efforts in oncology are designed to incentivize value-based care. Oncologists, who need to have some flexibility in their care decisions, often struggle with thinking in terms of value, notes Ward.
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Documentation associated with prior authorization and other cost-containment efforts places an administrative burden on oncologists, according to Jeffrey C. Ward, MD, who notes that he personally spends approximately 2 hours each day on such documentation. The result, he says, is less time for patient care.

Much of the burden is due to Medicare, not commercial payer requirements, since Medicare has a very complex claims-payment system, says Michael Kolodziej, MD. Both Medicare and commercial payers fall short in understanding what oncologists do, and thus apply sets of rules across the spectrum of healthcare that are not easily implemented in oncology, notes Kolodziej.

Prior authorization, which is designed to mitigate risk, is costly to both the oncology practice and the payer. There is still a need for oncologists to document that they are practicing evidence-based treatment, notes Kolodziej. However, this need will lessen as providers take on more risk. It is important that oncologists are held accountable for what they can control, not for what they cannot control, remarks Ward.

Payment reform efforts in oncology are designed to incentivize value-based care. Oncologists, who need to have some flexibility in their care decisions, often struggle with thinking in terms of value, notes Ward.
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