The American Society of Clinical Oncology says the CMS should look at episode-based or bundled payment instead of site neutral payment, as federally proposed.
ASCO says site neutrality—which would provide the same level of payment for oncology services whether they are provided in a hospital or physician's office—is based on a flawed and outdated approach.
Site-neutrality proposals from the CMS, Medicare Payment Advisory Commission and members of Congress focus on reducing payments without examining the consequences, according to an ASCO policy statement published in its Journal of Clinical Oncology.
ASCO also argues that the proposals rely on outdated reimbursement coding and would adversely affect the movement toward value-based care.
A bill calling for site neutrality was introduced two years ago by Reps. Mike Rogers (R-Mich.) and Doris Matsui (D-Calif.). In the bill's text, it was noted that Medicare paid $139 for one hour of chemotherapy infusion in an oncology practice office in 2012, but paid $208 for the same service in a hospital outpatient setting. That bill was vigorously opposed (PDF) by the American Hospital Association and did not make it out of committee.
ASCO says site-neutrality proposals rely on the fee-for-service system and fail to adequately pay for care-coordination and other services provided by new patient-centered oncology practice models.
These services include treatment planning, patient education and counseling, coordination of care, mental health assistance, use of patient navigators and triage nurses, genetic counseling, nutrition support, financial counseling, community outreach, and spiritual and emotional support.
“The lack of recognition of these essential services in the traditional coding and reimbursement systems used by Medicare and Medicaid in both the physician practice and hospital outpatient settings creates significant barriers to these important services for many individuals with cancer,” the ASCO committee wrote.
Using these services in transformational models of care can generate savings “dwarfing” anything that site neutrality could create. On the other hand, underpaying for these services would continue to hinder efforts to produce higher-quality, lower-cost oncology care, according to the ASCO statement.
In making its case, the ASCO panel cited a report written by Dr. John Sprandio Sr., whose Consultants in Medical Oncology and Hematology practice has three locations in the Philadelphia suburbs that adopted the primary-care patient-centered medical home concept for oncology.
“I fully agree and firmly believe that the entire oncology payment system can be re-designed to more fully align patient, provider and payer interests,” Sprandio said.
Sprandio added, however, that he did not fully agree “with all the details and complexity” included in the patient-centered oncology payment methodology that ASCO released this past May.
Sprandio also agreed that policymakers should reform Medicare reimbursement coding so that it is consistent with ASCO's proposals.
A representative of the American Hospital Association could not be reached for comment by deadline.