ASCO pro­poses re­formed pay model for can­cer care

Modern Healthcare - - NEWS - By Sabriya Rice

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.

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