Higher Cost IV Drugs Not Addressed by ASCO Payment Proposal

2 June, 2014, by ClinCaptureTeam

The American Society of Clinical Oncology (ASCO) made payments for oncology care a central focus of their meeting this week. In their paper released in May 2014 the ASCO Payment Reform Workgroup suggests a new payment scheme for oncology care. Oncology practices would receive five types of flexible, bundled payments designed to cover currently uncompensated time and costs in addition to services currently reimbursed. Currently, practices get reimbursed for patientface time with the physician and drug infusions but not for a lot of services now important in cancer therapy, such as, time spent with nurses, other staff like nutritionists needed for patient education or treatment planning.
The five proposed new payments include:

· Payment for new patient—higher than currently provided for initial visit
· Treatment month payment—set at 4 different levels depending on severity of patient condition and required supportive services. It would delete cost of drug infusion but cost of drugs would be still covered but separately.
· Active monitoring month payment—for care and support after medication therapy ends, such as, disease monitoring for recurrence or progression of disease.
· Transition of treatment payment—for treatment planning and patient education when treatment needs to be changed.
· Clinical trial payment—payment for services of physicians in providing clinical trial access and support.

The proposed additional new payments are supposed to provide improved care and value for the patient. The problem I see with the above is that the wording suggests lots of different interpretation in the “coding” involved in each of the five payments. They are too vague, not easily measurable and subject to upward slippage in cost. See full report here.

The real kicker in this proposal is the following: “In addition to the five consolidated payments, the practice would continue to receive separate payments for tests and major procedures it performs and reimbursement for the costs of purchasing and storing drugs the practice administers in the office.” I see real problem with double payments for services in their scheme.

In article entitled “Reforming Oncology” in the June 2, 2014 issue of BioCentury Senior Editor Erin McCallister says ASCO’s “newly unveiled payment model doesn’t yet address how physician practices actually should be paid for drugs. He goes on to remind us the ASCO approach does nothing to address the “elephant” in the room–the use of higher cost IV drugs vs. oral drugs to boost revenues. “Instead, payers are the ones taking the lead on new models that remove or lessen incentives to prescribe IV drugs to boost oncologist profits.” This thorough article discusses the new approaches of payers like Wellpoint and United Health that tackle this real problem which needs addressing.

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Reposted from Audrey Erbes’ blog: Audrey’s Network

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