Cancer treatment is unaffordable for a growing number of patients — including those who have “adequate” health insurance — with associated medical expenses being cited as one of the leading causes of personal bankruptcy. The American Society of Clinical Oncology (ASCO) has released a proposal that would help enable oncology practices to deliver higher-quality care at lower costs, primarily through a substantial restructuring of the way in which those practices are reimbursed.
Known as the Patient-Centered Oncology Payment (PCOP), this proposal ties quality of care to improved payment for oncology practices. Under PCOP, an oncology practice would be able to bill payors for four new service codes, allowing an increase in revenue of nearly 50%. In return for receiving these new payments, practices would be required to accept accountability for providing high-quality, evidence-based care meeting specific standards as defined by ASCO. Payors and, in turn, patients, who are greatly involved in the outlay of these increased payments, are anticipated to experience considerable savings through the reduced rates of care visits that tend to go hand-in-hand with better-quality healthcare. Savings would also result from other improved care measures, such as more appropriate use of expensive chemotherapy and other cancer drugs.
The new payment codes would cover services that are currently not billable—for example, non-face-to-face communications between patients and physicians, and services provided by non-physician staff. PCOP can also help compensate for insufficiencies in payments for billable services. Diagnosis and treatment planning—arguably the most important stages in patient care—are billable services that currently receive insufficient payment, and may therefore potentially be allotted inadequate resources. At present, Medicare can usually be billed for only about 24% of the total costs involved in these kinds of services, including physician visits and non-physician engagements such as family education, counseling, and administrative tasks (namely, for about one or two office visits with the physician). One of the new PCOP payment types, New Patient Treatment Planning payment, would be used to help cover the hours that oncologists need to spend outside the office visit on diagnosis and selection of appropriate treatment— for instance, in researching the literature.
Eligibility for an oncology practice’s continued participation in the PCOP program would be directly tied to total rates of emergency department visits and hospital admissions for its patients, ensuring reciprocity of high-quality care and sufficient payment for that care.
For more information, visit http://www.asco.org/advocacy/physician-payment-reform
About the Connexion Healthcare Oncology Center of Excellence
Connexion Healthcare is a full-service global provider of strategic medical and scientific communications with decades of experience providing exceptional service to the pharmaceutical industry. We provide services through 2 Centers of Excellence—Oncology and Rare Disease—and possess core expertise in these therapeutic areas and their marketplaces.
Connexion Healthcare’s Oncology Center of Excellence offers executive talent with decades of experience in the pharmaceutical industry. Our medical directors have conducted oncology research at leading institutions and major pharmaceutical companies. Our account leads have years of project execution expertise, and our medical editors are versed in the language of oncology. Our design leads are tops in their fields and ensure that your objectives are met effectively and even surpassed in an industry-eloquent and compliant manner. Our team works with you to conceive a strategy and execute communications through your product’s lifespan – from drug discovery through market launch and beyond. With particular expertise in phase 2 through postlaunch, we will engage with you wherever you are in development and whenever you need us.
For further information regarding the Oncology Center of Excellence at Connexion Healthcare and how we can develop oncology communications to differentiate therapies by their unique attributes, contact:
Larry Lunak, Senior Vice President
Valery Sudakin, PhD
Hematology/Oncology Scientific Services