Red Journal: Alternatives to fee for service

[Gfunk6]

I read a very interesting article in the Red Journal: http://www.redjournal.org/article/S0360-3016(14)00494-5/pdf

It discusses how RO utilization has risen tremendously and is unsustainable by CMS. Obviously 'bundled payments' are all the rage but the article thoughtfully goes through a few models in significant detail and their applicability to RO.

1. Single specialty capitation - if NCCN gives several, equivalent alternatives for a given stage of malignancy (e.g. brachy, IMRT, protons for early stage prostate cancer) then you choose the cheapest one because you receive a flat payment regardless of the expense on your end.

2. Multi-specialty capitation - as above but gives a larger, bundled payment to be divided up by surgeon, RO and MO.

3. Episodic payments - give an up-front, 'lump sum' payment for each treatment site by stage. This 'lump sum' includes consultation, simulation, treatment planning, treatment delivery and follow-up for 90 days. The money given to ROs is a weighted average. For instance reimbursement for Stage III NSCLC might be 60% 3DCRT + 40% IMRT.

The authors note that none is 'perfect' but advocate #3 as their preferred choice.

Very interesting read.

---

Members don't see this ad.

 

[medgator]

Interesting to see how this will pan out between the hospital-based and freestanding community. The former opposes it in general, while it is supported by the latter, since it would create site-neutral payments and create more clarity on reimbursements in future years.