ASCO Releases Proposal for Payment Reform to Support Higher-Quality, More Affordable Cancer Care
Expanding on the Consolidated Payments for Oncology Care (CPOC) payment model circulated last year to improve the quality and affordability of care for patients with cancer, ASCO’s new Patient-Centered Oncology Payment: Payment Reform to Support Higher Quality, More Affordable Cancer Care (PCOP) proposal would fundamentally restructure the way oncologists are paid for cancer care in the United States by providing sufficient payment to support the full range of services that patients with cancer need and removing the barriers created by the current payment system to delivering high-quality, affordable care. The proposal is designed to simultaneously improve services to patients and reduce spending for Medicare and other payers, according to a news release ASCO issued today.
Patient-Centered Oncology Payment Proposal
The PCOP proposal is designed to meet federal standards for Alternative Payment Models proposed in legislation Congress enacted last month to repeal Medicare’s sustainable growth rate formula. The new law, the Medicare Access and CHIP Reauthorization Act of 2015, encourages development of alternatives to the current Medicare fee-for-service payment system as a strategy to achieve higher-quality, more affordable care. ASCO’s PCOP proposal would enable oncology practices to take greater accountability for key aspects of cancer care spending without harming patients and without putting practices at risk for costs they cannot control.
PCOP also addresses the problem of inadequate payment for the wide range of services oncologists provide that are critical to supporting patients with cancer and managing their care, including:
- Education and support to help patients make the best treatment choices,
- Rapid response for patients experiencing problems during treatment to help avoid emergency department visits or hospitalizations,
- Care coordination with other health-care providers, and
- Continued support to patients after active treatment ends.
Three Payment Approaches
The new PCOP plan offers oncologists three payment approaches: basic, consolidated, and bundled.
Basic
Under the basic PCOP system, oncology practices would receive four supplemental, non–visit-based payments to support diagnosis, treatment planning, and care management. Oncology practices would bill payers for four new service codes. They include:
- New patient treatment planning: $750 payment for each new patient
- Care management during treatment: $200 payment each month for each patient
- Care management during active monitoring: $50 payment each month for each patient during treatment holidays and for up to 6 months following the end of treatment
- Participation in clinical trials: $100 per month payment for each patient while treatment is underway and for 6 months afterward
Practices would continue to be paid as they are today for services currently billable under the Medicare Physician Fee Schedule, including evaluation and management services, infusions of chemotherapy, and drugs administered or provided to patients in the practice setting. In return for receiving these payments, oncology practices would take accountability for providing high-quality, evidence-based care in four ways:
- Avoidance of emergency department visits and hospital admissions for complications of cancer treatment
- Appropriate use of drugs, laboratory testing, and imaging studies; and use of lower-cost drugs, tests, and imaging where evidence shows they are equivalent to higher-cost treatments and tests
- Delivery of high-quality care near the end of a patient’s life
- Commitment to care consistent with standards of quality defined by ASCO
Consolidated
The consolidated payment system would replace existing evaluation and management and infusion payments with three new consolidated sets of billing codes that provide oncology practices with more flexibility to determine exactly how to deliver effective services to patients. This option provides monthly payments matched to resources needed at various stages of a patient’s treatment. The consolidated system reduces the 58 CPT codes oncology practices currently use to bill for services and replaces them with fewer than 12 new payment codes. The new payment codes fall into three major categories:
- New patient payment
- Treatment month payment
- Active monitoring month payment
Bundled
This payment approach would set a target spending level to cover both the services delivered by the oncology practice and one or more other categories of services, such as hospital admissions, laboratory tests, imaging studies, and/or drugs.
Tailoring Services to the Needs of Patients
“With today’s health-care system in profound transition, 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, without increasing financial burdens on patients,” said Robin Zon, MD, FACP, FASCO, ASCO’s Clinical Practice Committee Chair, in a statement. “ASCO’s Patient-Centered Oncology Payment proposal not only provides that flexibility, but it will introduce much-needed stability into cancer care to ensure that patients receive the full range of services they need to fight their disease.”
Providing Feedback
ASCO is encouraging members to provide feedback on its PCOP proposal and is soliciting comments on the payment reform model through July 20, 2015.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
