Bundled payments in oncology

[Member223232]

We've have had a lot of discussion about bundled care in oncology recently (See ASTRO Job Market thread) but I think that thread is turning into a discussion about PP vs academic jobs so I wanted to start a new one.

A significant trend is emerging where payment models are constructed in such a way that medical oncologists are put as "the quarterback" of the oncology team and are incentived to save money by reducing costs (among them radiation oncology costs.) Many people see this as something far off in the distant future but I just read an article today that shows it is a lot closer than one thinks. We already have to defend the utility of radiation to skeptical medonc's and surgeons now, so imagine if a day comes when use of radiation actually decreases the income of these referring docs..........

http://www.medscape.com/viewarticle/853492

UnitedHealthcare said Thursday it will expand its high-profile test of whether bundled payments for chemotherapy can help slow rising cancer treatment costs, part of a growing effort by insurers to find new ways to pay for care.

[.....]​

At the end of the three-year study, even though spending on chemotherapy drugs rose substantially, the cost of caring for the patients was $33.4 million less than costs for a control group of similar patients who were not part of the study. All patients had either breast, colon or lung cancer. United redistributed one-third of the savings with the physician practices by increasing their patient payments for a second round of the pilot, which is still ongoing.

What, exactly, led to the cost savings isn’t clear. But Newcomer said a reduced number of hospitalizations and use of radiation services clearly contributed, adding that the next round of its pilot program may offer more complete answers.​

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[thesauce]

This was one successful pilot. There were several others that failed.

Savings can always be had, but the real question is whether the outcomes suffer. Interesting that they didn't seem to look at outcomes...

 

[medgator]

Chemo and hospitalization costs >>>> radiation costs. Astro needs to advocate at a national level regarding this and the dichotomy of radiation and systemic therapy in the treatment of cancer.

And as thesauce alluded to, you could see a backlash against the move towards capitation and "less being more."

death panels anyone? Hospice is an appropriate and cost-effective measure.... to a point

 

[radoncftw]

Chemo and hospitalization costs >>>> radiation costs. Astro needs to advocate at a national level regarding this and the dichotomy of radiation and systemic therapy in the treatment of cancer.

I think this is spot on. Working on a few cost-effective/utility analyses projects currently and it's crazy when you compare the cost/benefit of XRT vs. a few cycles of FOLFOX

 

[Gfunk6]

Bundled payments are our future, there is no getting around it. You can either think ahead and build figurative bomb shelters or be annihilated in the nuclear payment reform that is coming.

 

[thecarbonionangle]

How much less will rad onc make on average with bundles?

 

[PhotonBomb]

How much less will rad onc make on average with bundles?

This question does not make any sense. Also can't possibly be answered.

 

[medgator]

How much less will rad onc make on average with bundles?

Some are asking, "how much more can we make with it?"

Bundles may help stop the bloodletting in the freestanding centers and actually improve the situation in payment disparity between the hospitals and freestanding centers. It's all about how you handle this situation as gfunk alluded to.

Beyond that, its anybody's best guess. Having alliances and possibly being integrated with multispecialty groups will be key

 

[Sheldor]

Some are asking, "how much more can we make with it?"

Bundles may help stop the bloodletting in the freestanding centers and actually improve the situation in payment disparity between the hospitals and freestanding centers. It's all about how you handle this situation as gfunk alluded to.

Beyond that, its anybody's best guess. Having alliances and possibly being integrated with multispecialty groups will be key

This. How bundles effects us will entirely depend on who at the institutional level divy's up the pie. We want to make sure that Rad Oncs are on the committee that determines this. Or, if you are like some Rad Onc groups I know, its time to open a multi-specialty clinic and hire some med-oncs and surg oncs.

 

[2014XRT]

Some of the smarter hospital systems - like the Mayo System and The Cleveland Clinic - are already well on their way of coming up with institutional ways to handle bundled payments for oncology, with leadership from the different subspecialties. It will be important for everyone to realize that the best way to deal with this is to get ahead of the game and get a seat at the table.