ASCO proposes reformed pay model for cancer care
Oncologists have proposed a new payment model for cancer care using consolidated billing codes, bundled payments and care-management fees, which they hope will improve quality of care and reduce costs.
The American Society of Clinical Oncology updated its Patient-Centered Oncology Payment model last week. Participating oncology practices would commit to delivering evidence-based tests and treatments and avoiding unnecessary expenses. The goal is to address the serious financial challenges insurers and patients face as cancercare costs soar, while offering providers flexibility and stability in the way care is delivered, ASCO leaders said.
The PCOP model would consolidate billing codes into three categories— new patient, treatment and active mon- itoring—and reduce 58 procedure codes down to about a dozen. It includes a bundled-payment approach that would set target spending levels for services.
Participating insurers would be billed for four new service codes to support diagnostic, treatment and care-management planning. Those would include an initial $750 payment for treatment planning for new patients; a monthly $200 care-management fee for patients undergoing treatment; a monthly $50 fee for active patient monitoring during treatment breaks and up to six months following treatment; and $100 a month for each patient during treatment, as well as six months after treatment.
“We believe that PCOP would qualify as an alternative payment model, thereby help to advance federal goals for improving the quality and affordability of healthcare,” said ASCO President Dr. Peter Yu, whose group is soliciting comments on the model through July 20 from payers, cancer-care providers, analysts and policymakers.
Medical spending to treat cancer increased from $56.8 billion in 2001 to $88.3 billion in 2011, according to estimates from the Agency for Healthcare Research and Quality.
Medicare and private insurers are also testing bundled-payment strategies to control rising cancer-care costs. The CMS recently invited oncology practices and solo practitioners to join a five-year test that includes episode-and performance-based payments designed to reward quality and care coordination. That project is set to begin in the spring of 2016.
Last summer, UnitedHealthcare announced that a payment model it tested with five oncology groups, in which physicians were reimbursed a fixed price for their patient outcomes and use of best practices, led to a net savings of more than $33 million between October 2009 and December 2012.