The high costs of cancer care are unsustainable, both for individual patients and for society.
That’s the conclusion of the workshop, “Ensuring Patient Access to Affordable Cancer Drugs,” convened by the 2014 National Cancer Policy Forum of the Institute of Medicine in Washington, DC, the proceedings of which were recently published.
One underlying tenet of the workshop is that “to improve cancer care, there is a need to consider patient access to appropriate cancer drugs and other treatments broadly.”1
Workshop participants noted that rising costs of cancer care could be countered by “value-based insurance design and drug pricing, episode-based reimbursements, and incentives for patients and their physicians to opt for lower cost care without compromising the quality of that care.”1
What does that mean for practicing clinicians?
Specifically, they should be “empowered” and “incentivized” to use high-value treatment options. Workshop participants recommended the following:1
- Design electronic medical records to provide information on the evidence base and cost for a treatment.
- Encourage greater use of practice guidelines and more consistency among payers regarding the guidelines used.
- Establish reimbursement rates based on data from relevant patient populations.
- Reform reimbursement practices to replace the traditional “buy and bill” way of doing business in oncology.
- Reimburse the chemotherapy administration fee separately from the drug fee.
- Adequately compensate oncologists for the complex and time consuming care they offer patients.
- Use bundled payments tied to metrics to incentivize efficient care and good patient outcomes.
- Educate physicians on cost-cutting strategies, such as prescribing generics, offering less expensive therapeutic alternatives, and offering discount cards.
- Provide guidance to eliminate care for which the evidence convincingly shows a lack of value or potential harm to patients.
- Develop policies that incentivize oncologists to stay in private practice such as:
- Provide payment parity for administrative services for the hospital versus the physician office.
- Remove the sequestration cuts to Medicare Part B drugs.
- Remove prompt pay discounts from the calculation of the average sales price.