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Moving Away From Traditional Payment Models in Oncology

Panelists:Michael Kolodziej, MD, Aetna; Andrew L. Pecora, MD, FACP, CPE, John Theurer Cancer Center; Jeffery C. Ward, MD, Swedish Cancer Institute
Published: Thursday, Aug 27, 2015

 
The “buy and bill” reimbursement model has dominated oncology practice for many years. However, this system is problematic, since it creates the impression that there is a conflict of interest, notes Michael Kolodziej, MD. Under this model an oncology practice can make more money by treating less complicated cancers, since certain drugs have greater profit margins, adds Kolodziej.

The current reimbursement model will need to change, and the concept of incentivizing quality is good in theory, notes Kolodziej. However, the solution is far more complicated than just replacing the "buy and bill" model with one based on outcomes.
 
Fee-for-service has similar disincentives, according to Jeffrey C. Ward, MD. The clinics are able to bill for infusions and patient visits, but reimbursement is lacking for nutrition consultations, social worker consultations, financial counseling, and patient education. Oncology clinics can offer these additional services in part because of the profit they receive through buy-and-bill, adds Ward.
 
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The “buy and bill” reimbursement model has dominated oncology practice for many years. However, this system is problematic, since it creates the impression that there is a conflict of interest, notes Michael Kolodziej, MD. Under this model an oncology practice can make more money by treating less complicated cancers, since certain drugs have greater profit margins, adds Kolodziej.

The current reimbursement model will need to change, and the concept of incentivizing quality is good in theory, notes Kolodziej. However, the solution is far more complicated than just replacing the "buy and bill" model with one based on outcomes.
 
Fee-for-service has similar disincentives, according to Jeffrey C. Ward, MD. The clinics are able to bill for infusions and patient visits, but reimbursement is lacking for nutrition consultations, social worker consultations, financial counseling, and patient education. Oncology clinics can offer these additional services in part because of the profit they receive through buy-and-bill, adds Ward.
 
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