How to Pay for Cancer Care

FigureCancer care providers—and payers—agree that a new way for paying for cancer treatment and follow-up monitoring must be found, but exactly what that new pay system should be remains unclear. The American Society of Clinical Oncology and the Community Oncology Alliance are advancing the discussion by jointly issuing a set of payment reform principles. They agree with everyone else that Medicare's current system—paying the average sales price for cancer drugs plus six percent—is insufficient to cover the costs of most oncology practices and it does nothing to differentiate between physicians who provide high-quality care and those who do not. The joint principles include: Oncology professionals should take a lead in developing new care models, which must promote access to evidence-based care, improve quality, and help control costs. Changing to new care models requires significant expense, time, and effort so changes in payment models should be incremental over a period of time. Oncology providers should be protected against new pay policies that will undermine their ability to invest in their practice changes. Quality measures should play an important role in evaluating and paying oncology providers. One-size-fits-all may not apply to oncology delivery or pay models. Rather, providers should be able to choose the approach that fits best in their community. Indeed, ASCO and COA each has its own proposal for cancer care payment reform. ASCO wants to see monthly payments for cancer care in which the payment amount reflects the particular stage of care, such as treatment, non-treatment and transition of treatment. Additionally, ASCO proposes additional compensation for performance on quality measures, adherence to cancer care pathways, management of patient care that reduces emergency and inpatient care, and participation in clinical trials. Meanwhile, COA is promoting a pay system that would support its Oncology Medical Home practice model. Its concept, which would be phased in over five years, would gradually replace fee-for-service with episode-of-care payment and shared savings that reward clinicians for high- quality care delivered at the lowest possible cost. Do either of these proposals sound feasible? Please let me know—tweet me at @LolaButcher, or email [email protected]