Value-based payment in cancer care can work with personalized medicine, but providers need to be the ones who tell policymakers how value should be defined, a health policy expert said Thursday at the annual meeting of the Association of Community Cancer Centers.
Dr. Kavita Patel, with the Brookings Institution, said that alternative payment models being pushed by politicians need to be clear on what a good outcome is in oncology.
“We do not want to wait for Congress or the federal government to tell us what value is, especially in cancer care,” she said.
Oncologists have been at the forefront of personalized or precision medicine with treatment targeting certain cancers, but doctors must articulate how they actually treat patients, she said.
Patel said she has participated in multiple discussions with policymakers who are not practitioners trying to develop alternative payment models. She often tells them that what sounds great in a boardroom doesn't always translate to success in a doctor's office.
“It's so hard to communicate with policymakers what it's like in the real world,” she said.
The intuitive clinical thought process that cancer care providers all develop and use should be part of any value-based payment. And continuing education required to maintain licensing should take into account the copious research required to keep up with developing therapies, she said.
“The goal is to identify the mechanism of cancer progression at the individual level in order to target it,” she said.
Another topic at the conference was new site-neutral payment regulations for hospital outpatient departments, which Congress decided to implement as a $9.3 billion pay-for in a budget agreement last year.
Ronald Barkley, with the Cancer Center Business Development Group, said physician offices tend to view the provision favorably and say that without it there is unfair competition. Hospitals, on the other hand, say the higher payment is justified because they have stricter standards and offer more services.
Regardless, there are still questions to be resolved, including whether new hospital outpatient departments would be eligible for the 340B Drug Pricing Program that provides drug discounts to hospitals with disproportionate shares of low-income patients, he said.
“We shouldn't go about the restricting of payment without looking at the full picture and understanding what the downstream consequences might be of site-neutral payment,” he said.
