Payment reform in oncology is not new, but since most of the models proposed in the past have required wholesale changes in practice, care delivery, or administrative structure, oncology practices have been reluctant to embrace significant change. Forcing practices to adopt these changes is impractical.
An innovative payment approach, called “Consolidated Payments for Oncology: Payment Reform to Support Patient-Centered Care for Cancer” and 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. Further details about these payment models can be found here.
“I think that bundles have been tried in the past. We called it capitated care. The difference is that we have systems like QOPI – the Quality Oncology Practice Initiative-- that can measure quality,” said Jeffery Ward, MD, chair of ASCO’s Payment Reform Group and a practicing oncologist at the Swedish Cancer Institute.
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.
Simpler billing structure. The model significantly reduces administrative burdens on oncology practices and simplifies cost-sharing by streamlining the number of billing codes required.
More predictable practice revenues. This would provide practices a more predictable monthly revenue stream, making revenue less dependent on infusion chemotherapy drugs.
Accountability for delivering high-quality, evidence-based, patient-centered care. Practices that deliver higher quality care that meets national standards could eventually 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 this new payment model, the group 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.