Meaningful Physician Payment Reform in Oncology

2013 ◽  
Vol 9 (6S) ◽  
pp. 49s-53s ◽  
Author(s):  
Kavita K. Patel ◽  
Alexander J. Morin ◽  
Jeffrey L. Nadel ◽  
Mark B. McClellan
Keyword(s):  
Cancer Care ◽  
Reimbursement System ◽  
Fee For Service ◽  
Physician Payment ◽  
Payment Reform ◽  
Payment Model ◽  
New Models

The authors describe various new models of physician payment that can serve as a foundation for a shift away from the current reimbursement system for cancer care to support better outcomes and avoid preventable costs, as well as how these reforms can be supported in a blended payment model that transitions away from but still contains elements of fee-for-service payments.

The Patient-Centered Medical Home in Oncology: From Concept to Reality

2015 ◽  
pp. e82-e89 ◽  
Author(s):  
Ray D. Page ◽  
Lee N. Newcomer ◽  
John D. Sprandio ◽  
Barbara L. McAneny
Keyword(s):  
Medical Home ◽  
Cancer Care ◽  
Financial Risk ◽  
Cost Curve ◽  
Patient Centered Medical Home ◽  
Financial Risks ◽  
Fee For Service ◽  
Payment Reform ◽  
Patient Centered ◽  
The Cost

In recent years, the cost of providing quality cancer care has been subject to an epic escalation causing concerns on the verge of a health care crisis. Innovative patient-management models in oncology based on patient-centered medical home (PCMH) principles, coupled with alternative payments to traditional fee for service (FFS), such as bundled and episodes payment are now showing evidence of effectiveness. These efforts have the potential to bend the cost curve while also improving quality of care and patient satisfaction. However, going forward with FFS alternatives, there are several performance-based payment options with an array of financial risks and rewards. Most novel payment options convey a greater financial risk and accountability on the provider. Therefore, the oncology medical home (OMH) can be a way to mitigate some financial risks by sharing savings with the payer through better global care of the patient, proactively preventing complications, emergency department (ED) visits, and hospitalizations. However, much of the medical home infrastructure that is required to reduced total costs of cancer care comes as an added expense to the provider. As best-of-practice quality standards are being elucidated and refined, we are now at a juncture where payers, providers, policymakers, and other stakeholders should work in concert to expand and implement the OMH framework into the variety of oncology practice environments to better equip them to assimilate into the new payment reform configurations of the future.

Society of Gynecologic Oncology Future of Physician Payment Reform Task Force report: The Endometrial Cancer Alternative Payment Model (ECAP)

2018 ◽  
Vol 149 (2) ◽  
pp. 232-240 ◽  
Author(s):  
Emily M. Ko ◽  
Laura J. Havrilesky ◽  
Ronald D. Alvarez ◽  
Oliver Zivanovic ◽  
Leslie R. Boyd ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Task Force ◽  
Gynecologic Oncology ◽  
Physician Payment ◽  
Payment Reform ◽  
Task Force Report ◽  
Payment Model

Physician Payment Reform

JAMA ◽  
1994 ◽  
Vol 272 (24) ◽  
pp. 1890
Author(s):  
Bruce C. Vladeċk
Keyword(s):  
Physician Payment ◽  
Payment Reform

Perspectives: Physician Payment Reform: Lessons From Abroad

1989 ◽  
Vol 8 (4) ◽  
pp. 76-83 ◽  
Author(s):  
Victor G. Rodwin
Keyword(s):  
Physician Payment ◽  
Payment Reform

Physician reimbursement under Medicare

2002 ◽  
Vol 12 (4) ◽  
pp. 1-4 ◽  
Author(s):  
Alan M. Scarrow
Keyword(s):  
United States ◽  
The United States ◽  
Payment System ◽  
Reimbursement System ◽  
Physician Services ◽  
Physician Payment ◽  
Value System ◽  
Physician Reimbursement ◽  
Surgical Services ◽  
Relative Value

Payment for physician services in the United States is directly tied to the payment system implemented in the Medicare system. The use of a code to categorize medical and surgical services, as well as a relative value system to assess physician services and reimburse them accordingly, is now well established. In light of this, it is important for physicians to possess knowledge of how this coding and reimbursement system was established, how it is updated, what means are available to modify it, and how it is used in practice. The author addresses these issues, offering a primer for the neurosurgeon on the Medicare system as it relates to physician payment.

Disproportionate Negative Impact of the Radiation Oncology Alternative Payment Model on Rural Providers: A Cost Identification Analysis of Medicare Claims

2021 ◽  
pp. OP.21.00330
Author(s):  
Constantine A. Mantz ◽  
Nikhil G. Thaker ◽  
Praveen Pendyala ◽  
Anne Hubbard ◽  
Thomas J. Eichler ◽  
...  
Keyword(s):  
Radiation Oncology ◽  
Negative Impact ◽  
Quality Care ◽  
Fee For Service ◽  
Current Form ◽  
Payment Model ◽  
Physician Practices ◽  
Bundled Payments ◽  
Treatment Services ◽  
Rural And Urban

PURPOSE: The Radiation Oncology Alternative Payment Model (APM) is a Medicare demonstration project that will test whether prospective bundled payments to a randomly selected group of physician practices, hospital outpatient departments, and freestanding radiation therapy centers reduce overall expenditures while preserving or enhancing the quality of care for beneficiaries. The Model follows a complicated pricing methodology that blends historical reimbursements for a defined set of services made to professional and technical providers to create a weighted payment average for each of 16 cancer types. These averages are then adjusted by various factors to determine APM payments specific to each participating provider. METHODS: This impact study segregates APM participants into rural and urban groups and analyzes the effect of the Radiation Oncology Alternative Payment Model on their fee-for-service reimbursements. RESULTS: The main findings of this study are (1) the greater net-negative revenue impact on rural facilities versus urban facilities that would have participated in the Model this year and (2) the relative lack of high-value treatment services (ie, stereotactic radiotherapy and brachytherapy) delivered by rural facilities that exacerbates their negative impact. CONCLUSION: As such, rural providers participating in the Model in its current form may face greater risk to their economic viability and greater difficulty in funding technology improvements necessary for the achievement of high-quality care compared with their urban counterparts.

Physician Payment Reform: Congress's Turn

1989 ◽  
Vol 111 (5) ◽  
pp. 351
Author(s):  
Robert A. Berenson
Keyword(s):  
Physician Payment ◽  
Payment Reform

Physician Payment Reform: Finally

1987 ◽  
Vol 107 (6) ◽  
pp. 929
Author(s):  
ROBERT A. BERENSON
Keyword(s):  
Physician Payment ◽  
Payment Reform
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