Proposal for Cancer Payment Reform Falls Short

New models need to ensure equal access to high-quality care and medical innovation.

ASCO Consolidated Payments for Oncology Care

Read the complete proposal at ASCO.org.

The American Society of Clinical Oncology (ASCO) has proposed a new payment model for cancer care designed to pay doctors for currently uncompensated time spent taking care of their patients. While the proposal is an ambitious vision for cancer care, it currently does not provide enough details on how it will ensure quality of care and access to innovation.

The authors propose determining the quality of care with a set of measures that are not clearly laid out in the proposal and are not currently used by community oncology centers. Without clearly defined patient-centric quality measurements that represent a diverse set of stakeholder input, incentives could be misaligned and fail to provide improved value to patients, payers and providers.

In contrast, other proposed models, such as the one developed by the Community Oncology Alliance, provide more of a roadmap for implementation. The COA model uses 19 oncology measures determined by payers, providers and administrators. Because these measures are already part of the infrastructure of cancer care today, the plan can be and has been modeled by third-party actuaries who have confirmed the potential of the proposal.

Meanwhile some stakeholders feels ASCO’s plan would be difficult to implement because of current infrastructure restrictions. The plan claims to simplify administrative tasks, but some feel it could actually complicate things, as practices and insurers would need to develop and use new systems to gather and report these additional data.

“ASCO’s model would be brilliant if we could start all over and didn’t have the infrastructure limitations that we currently have,” said Bo Gamble, director of strategic practice initiatives for the Community Oncology Alliance. “If you look at the authors of this plan, they’re physicians. If you look at the people managing their practices, they’re not physicians but administrators who understand process, regulation and reimbursement—people who can say ‘here’s my infrastructure, and here’s what has to work.’”

The model proposed by ASCO goes part way to eliminating the incentive for favoring IV drugs over oral medications.

Even if ASCO’s payment plan were to be implemented, it might not go far enough to improve patient care and access to medical innovation. The proposed payment model seeks to remove existing financial incentives that can discourage the use of oral therapies.

Under ASCO’s proposed payment model, a flat monthly treatment payment would be paid to an oncology practice each month a patient is on treatment, regardless of whether the therapy is intravenous (IV) or oral.

“The model proposed by ASCO goes part way to eliminating the incentive for favoring IV drugs over oral medications,” Karen Van Nuys, senior research economist at Precision Health Economics, said. “It doesn’t go all the way in terms of making those two things equal.”

One thing is clear: the current payment system does not always provide cancer patients with the most innovative treatments that allow them to live healthier lives. Payment reform should continue to be explored and refined, so that all oncology practices can participate and provide the most benefits for their patients, health care and the economy.