|
Cancer Care Braces for a Tsunami
Elsevier Global Medical News. 2009 Feb 10, C Helwick
SCOTTSDALE, Ariz. (EGMN) - Powerful forces are building that could radically alter the payment system for the delivery of cancer care.
At the annual Community Oncology Conference, Ted Okon, executive director of the Community Oncology Alliance in Washington, described the potential changes as a "tsunami" involving "catastrophic shifts."
Cancer care is in the spotlight of health care reform because of the sheer number of cancer patients and survivors, the aging population, and the steep increase in costs associated with modern drugs, Mr. Okon said. "The result could be a fundamental and potentially devastating impact on the cancer care delivery system, which is already under strain.
"Community oncology practices are already adversely impacted by Medicare cuts to drug and service payments. They are swamped by the government quest to pay for quality versus quantity. This is where the health care system must go, and it sounds great on paper, but it could be one giant cost-cutting exercise," said Mr. Okon.
"This is not all bad news," he added. "It's a call to action for community oncologists to step up and be proactive, unified, and vocal, and to produce data to help shape payment reform."
According to Mr. Okon, the payment landscape could be reshaped by a number of potential changes:
-Determination of therapy by the Centers for Medicare and Medicaid Services (CMS) with treatment dictated by CMS' payment leverage.
-Reform of the physician payment system, which is currently based on the sustainable growth rate (SGR).
-Resurrection of the competitive acquisition program (CAP).
-Pursuit of the primary care medical home concept.
-Institution of value-based purchasing.
-Institution of service bundling and episodes of care.
-Development of comparative effectiveness systems.
Together, these could spell big changes for community oncologists, he said. The definition of "medically necessary" may change and become the purview of the CMS. Medical specialties that provide more expensive care likely will experience a decrease in payment for services, and the following of quality standards and measures currently is evolving from a means to a bonus to a future requirement and on to a penalty those who do not comply.
The renewal of CAP could create a radical change to the current "practice-based, just-in-time drug" distribution system. Finally, adoption of the medical home model could result in increased payments to primary care doctors coupled with cuts in specialty care payments, he predicted.
Of all the forces, value-based purchasing and services bundling could create the most fundamental shifts in reimbursements to community oncology practices, Mr. Okon said.
Physicians would be moved from a per-service payment system to one based on outcomes, with the "risk element" placed squarely on the practices. And while comparative effectiveness could be a good thing, it has the potential of allowing government to "trump" oncologists' decision making and to focus more on cost than on quality, he said.
This is the second of the two articles linked. Thanks, Joe, for taking care of the first one.
Hopeful
|