A payment reform strategy offering consolidated billing codes and bundled cancer-care payments aims to “fundamentally restructure” the way cancer care is paid for in the U.S. New details about the Patient-Centered Oncology Payment model were released Thursday by the American Society of Clinical Oncology.
Participating oncology practices would commit to delivering evidence-based tests and treatments and avoiding unnecessary expenses. The goal of the PCOP is to address the serious financial challenges payers and patients face amid skyrocketing and unsustainable cancer-care costs, while offering providers flexibility and stability in the way care is delivered, ASCO leaders said.
The healthcare system is undergoing a “profound transition,” the group's Clinical Practice Committee Chair, Dr. Robin Zon, said in a press announcement. “It is critically important that payment systems provide medical practices with the flexibility needed to be compensated fairly and adequately, preventing disruption to the care we provide patients, and allowing physicians to tailor services to the unique needs of individual patients.”
The PCOP model focuses on three payment approaches. First, it consolidates billing codes into three categories—new patient, treatment and active monitoring—and reduces 58 procedure codes down to about a dozen. Second, it includes a bundled-payment approach that would set target spending levels for services.
Third, payers would be billed for four new service codes to support diagnostic, treatment and care management planning for patients. Those would include an initial $750 payment for treatment planning for new patients; a monthly $200 care-management payment for patients undergoing treatment; a monthly $50 payment for active patient monitoring during treatment breaks and up to six months following treatment; and $100 per month for each patient during his or her 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 health care,” said ASCO President Dr. Peter Yu.
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. Several payers, including the federal government, have experimented with bundled-payment strategies in recent years to help control costs.
In February, as part of a broader federal push to reward hospitals and doctors for value rather than the volume of services they provide, the CMS invited oncology practices and solo practitioners to join a five-year test model 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 in five medical oncology groups, in which physicians were reimbursed a fixed price for their use of best practices and patient outcomes, led to a net savings of more than $33 million between October 2009 and December 2012.
Cancer care payment reform is expected to be a high-profile topic at the annual ASCO conference, expected to draw more than 30,000 attendees to Chicago's McCormick Place, May 29 through June 2.
Updates are also anticipated on CancerLinQ, a cancer-quality initiative that uses electronic health records to share previously inaccessible cancer-care data, and on the Targeted Agent and Profiling Utilization Registry, a study to collect real-world data on clinical outcomes among patients receiving molecularly targeted cancer drugs.