Advocates concerned oncology payment model could leave radiologists in the cold
The American College of Radiology is concerned a potential cancer care payment model is too “oncology centric,” and could push providers to select imaging services based on cost alone, rather than quality.
Worries stem from the federal government exploring a new Oncology Care First Model, which would wrap all payments for a cancer care episode, spanning six months after the delivery of chemotherapy, into one check. This could potentially include radiation therapy along with imaging and lab work.
The ACR noted, however, that oncologists have little control over the treatment patients may need in the six months following chemo. And expanding the episode-of-care payment to include everything from interventional radiology to radiation therapy could lead to underutilization just to save money, the college wrote in a Dec. 13 letter to Centers for Medicare & Medicaid Services chief Seema Verma.
Oncology providers should continue to refer patients to radiology offices and imaging centers, and pay for them under the typical fee-for-service basis, argued CEO William Thorwarth, MD.
“The ACR is concerned that bundling imaging into the OCF episode of care would incentivize model participants to seek cost savings by choosing imaging providers based on cost alone,” he wrote. “Disregarding quality and safety issues may have deleterious consequences outside of the six-month accountable window of care. High exposure to radiation, unnecessary contrast exposure, use of low-quality equipment and repeat non-diagnostic scans are a few of the potential pitfalls of choosing an imaging provider solely on cost.”
CMS has held public listening sessions on the potential new payment model, and sent out an informal request for feedback in the fall, with a deadline of Dec. 13. The OCF would build upon the lessons learned in the currently ongoing five-year Oncology Care Model, which uses a fee-for-service framework and is scheduled to end in 2021. The new model would be voluntary and include both physician practices and outpatient hospital departments. CMS said it hopes to determine whether paying for cancer care in one lump sum will help to improve coordination and reduce unnecessary expenditures in the Medicare program.
“The inefficiency and variation in oncology care in the United States is well documented, with avoidable hospitalizations and emergency department visits occurring frequently, high service utilization at the end of life, and use of high-cost drugs,” the agency noted in its announcement.
If it decides to move forward with the new five-year payment model, CMS anticipates a January 2021 launch date.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.