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May 12, 2014

ASCO Releases New Oncology Payment Methodology Framework

Published

May 12, 2014

On May 5, the American Society of Clinical Oncology (ASCO) released a novel methodology for physician payment for cancer care services under Medicare.

The ASCO Payment Reform Workgroup developed the proposed structure known as the Consolidated Payments for Oncology: Payment Reform to Support Patient-Centered Care for Cancer. Akin to other proposed payment models, ASCO’s methodology shifts away from fee-for-service (FFS) and structures physician reimbursement around bundled payments to more accurately reflect services provided at different stages of treatment.

Under the proposed methodology, oncology practices would receive flexible bundled payments, including: ASCO’s proposed payment methodology also hopes to simplify oncology billing structure by improving and reducing the number of CPT codes, improving oncology practice revenue predictability, increasing provider accountability, and supporting coordinated patient-centered care. ASCO also proposes that the new payment mechanism should be not result in an increase or decrease in total payments by health plans or Medicare to oncology practices.

  • New Patient Payment: Payment intended to cover the cost of new patient visits (i.e. physician/staff time, patient evaluation, treatment planning, patient education, etc.) which is expected to be greater than what oncology practices currently receive for initial office visits. Treatment Month Payment: Tiered monthly payment over the course of a patient’s treatment irrespective of whether cancer drugs administered are oral or infused/injected. Oncology practices would receive one of four levels of payment, intended to reflect the differences in time and effort involved in treating different patients.
  • Active Monitoring Month Payment: Tiered payment during months when a patient is not receiving medical treatment, however still obtaining care/support from an oncology practice, including testing and monitoring associated with recurrences and the detection of cancer progression.
  • Transition to Treatment Payment: Tiered payment during months when a patient’s disease has progressed or changed, and requires new treatment and additional time and patient education.
  • Clinical Trial Payment: Additional monthly payment for patients participating in clinical trials.

The proposed draft methodology will likely be weighed by oncology stakeholders over the coming months; however, its adoption by Medicare and/or private payers remains unclear. Moreover, payers could elect to selectively adopt or explore specific aspects of the proposed methodology. ASCO is seeking input and encourages the oncology community to review and engage in a national dialog on the proposal.

View ASCO’s full proposal.

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