Payment Differences between Hospital and Free-standing centers

[radninja]

Recently came across this bill being introduced by Mike Rogers of Michigan to make payments for cancer services equal regardless of where they are provided. Seems like its gaining some traction and publicity. Thoughts on this and/or has ASTRO come out with any statements on this bill or similar ones recently?
http://www.kaiserhealthnews.org/Sto...QsCqWbTFE4HAUzyGRa8tZfx8lkeJeg&_hsmi=12858422

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[medgator]

This is being pushed by the free-standing/private community (US Oncology/Vantage/21st Century/RTA etc) and is opposed by hospitals (and likely ASTRO, which is mainly headed by hospital-based academic MDs).

It makes a lot of sense to me, and parallels what has been going on in many other fields (med onc, cards, etc.). Nuc Cardiology tests or chemo given in the outpatient setting costs the system less than those that are done in the hospital.

There are a few threads that have explored this subject:

http://forums.studentdoctor.net/threads/yes-radiation-oncology-is-2.1064816/
http://forums.studentdoctor.net/threads/be-careful-what-you-wish-for.1062624/
http://forums.studentdoctor.net/threads/some-good-news-on-the-reimbursement-front-finally.1044295/

Another thing that is supported by the free-standing community (and opposed by ASTRO) is bundled payments: http://insidehealthpolicy.com/Insid...rapists-split-on-bundled-pay/menu-id-869.html

 

[Sheldor]

This is being pushed by the free-standing/private community (US Oncology/Vantage/21st Century/RTA etc) and is opposed by hospitals (and likely ASTRO, which is mainly headed by hospital-based academic MDs).

It makes a lot of sense to me, and parallels what has been going on in many other fields (med onc, cards, etc.). Nuc Cardiology tests or chemo given in the outpatient setting costs the system less than those that are done in the hospital.

There are a few threads that have explored this subject:

http://forums.studentdoctor.net/threads/yes-radiation-oncology-is-2.1064816/
http://forums.studentdoctor.net/threads/be-careful-what-you-wish-for.1062624/
http://forums.studentdoctor.net/threads/some-good-news-on-the-reimbursement-front-finally.1044295/

Another thing that is supported by the free-standing community (and opposed by ASTRO) is bundled payments: http://insidehealthpolicy.com/Insid...rapists-split-on-bundled-pay/menu-id-869.html

It seems like the views about bundled payments should be reversed. Why do you suppose free-standing centers would approve of bundled payments?

 

[medgator]

It seems like the views about bundled payments should be reversed. Why do you suppose free-standing centers would approve of bundled payments?

To provide long-term stability in payments and perhaps even a move towards site-neutral payments (where the bundle would apply to both hospital and freestanding settings). It also would promote quality rather than quantity of care. No incentive to unnecessarily fractionate, do IGRT, etc.

Free-standing centers have been getting hit with the brunt of the medicare cuts the last several years.

 

[Sheldor]

To provide long-term stability in payments and perhaps even a move towards site-neutral payments (where the bundle would apply to both hospital and freestanding settings). It also would promote quality rather than quantity of care. No incentive to unnecessarily fractionate, do IGRT, etc.

Free-standing centers have been getting hit with the brunt of the medicare cuts the last several years.

That makes sense to me, though it seems that bundled payments would be tough for multi-disciplinary practices and my lead to a lot of fighting between rad oncs, med oncs and surg oncs.

I worry that it would make it that much easier for medicare to slash reimbursements. If they cut a bundled payment there is nothing than can be done to try and make up that difference.

 

[Irradi8or]

That makes sense to me, though it seems that bundled payments would be tough for multi-disciplinary practices and my lead to a lot of fighting between rad oncs, med oncs and surg oncs.

I worry that it would make it that much easier for medicare to slash reimbursements. If they cut a bundled payment there is nothing than can be done to try and make up that difference.

Global payments are the inevitable trend for most medical services, including cancer care. With proper value-based incentives, most think that bundles may promote quality rather than simply a quantity mentality. There will definitely be challenges on how to "unbundle the bundle".

 

[medgator]

Global payments are the inevitable trend for most medical services, including cancer care. With proper value-based incentives, most think that bundles may promote quality rather than simply a quantity mentality. There will definitely be challenges on how to "unbundle the bundle".

Correct. Medicare is moving towards an emphasis on quality of care and bundling. In that vein, the freestanding community is farther along than astro

 

[domestique]

posted to wrong thread