ASCO Proposes Overhaul of Medicare’s Oncology Payment System

May 30, 2014
Janet Colwell
Janet Colwell

Medicare’s payment system for cancer care services should be restructured to focus on value over volume and offer incentives for providing high-quality, patient-centered care.

Medicare’s payment system for cancer care services should be restructured to focus on value over volume and offer incentives for providing high-quality, patient-centered care, according to a new proposal from the American Society of Clinical Oncology (ASCO).

“The current Medicare physician payment system does not recognize cognitive-based services nor does it reimburse for critical patient support services that practices provide, such as nutritional guidance and symptom management,” says ASCO president-elect Peter Yu, MD, in an ASCO news release. “At the same time, soaring healthcare costs are creating untenable instability in the cancer community.”

The proposal, “Consolidated Payments for Oncology: Payment Reform to Support Patient-Centered Care for Cancer,” notes that the current system pays oncologists only for in-person office visits and medication administration but not for other essential services, such as phone and email communication with patients, counseling services, and managing oral medications. Under the proposal, oncologists would receive five types of monthly payments based on stage of treatment: new patient visits; active treatment; active monitoring; transition of treatment; and clinical trial.

In addition to the five bundled monthly payments, oncologists would continue to receive separate payments for tests and major procedures and reimbursement for drugs for administration. The proposal is intended as a model that can be customized to accommodate individual practices of different sizes and demographics.

“We believe we have identified the essential elements of what a patient-centered, oncology-specific payment system should look like,” said Jeffrey Ward, MD, chair of ASCO’s payment reform workgroup. “Additional piloting by oncology practices will help identify specific strengths and weaknesses in our proposal to guide further refinements going forward.”

The proposal will improve patient care and practice operations in several key ways, according to ASCO:

• Coordinated patient-centered care. Oncologists would have the flexibility and resources they need to deliver high-quality care at an affordable cost.

• Simpler billing structure. The number of billing codes would be cut from 58 to 11, reducing administrative burdens and simplifying cost-sharing.

• Predictable revenues. Practices would receive more predictable monthly payments and be less dependent on revenue from infusion chemotherapy.

• Accountability. Practices that meet national standards for quality would receive up to 10% higher payments while payments would be cut by 10% for those that do not deliver recommended care.

ASCO called on Congress to consider the proposal as a new model for oncology payments under Medicare reform. The group has posted the complete text of the proposal online and is soliciting comments.

“We encourage every oncologist in this country to review and provide feedback on our proposal,” says Yu. “Each one of us has a vitally important responsibility to help shape future cancer care in America, and this effort plays a key role.”