Costs of Cancer Care: A View From the Centers for Medicare & Medicaid Services

2007 ◽  
Vol 25 (2) ◽  
pp. 187-190 ◽  
Author(s):  
Peter B. Bach
Keyword(s):  
Cancer Care ◽  
The United States ◽  
Care Quality ◽  
Fee For Service ◽  
Substantial Portion ◽  
Physician Services ◽  
Therapeutic Approaches ◽  
Incentive Structures ◽  
Oncology Care ◽  
Payment Policies

Fee-for-service Medicare pays for a very substantial portion of all cancer care delivered in the United States. By virtue of its size and visibility, its payment policies at times also influence those of other health care payers. As a result, Medicare affects both the overall economics and the incentive structures of oncology care. Three aspects of how Medicare finances cancer care are particularly germane to the issue of costs. First, Medicare finances all aspects of cancer care in independent payment units, paying separately for physician services, laboratory tests, procedures, imaging, radiation, drug administration, and drugs. Second, Medicare is currently managing and monitoring a very substantial overhaul in payment for cancer care, which aims to reduce or eliminate incentives that have favored aggressive and costly treatments in clinical situations where alternative therapeutic approaches might have been equivalent or preferable. Third, Medicare is trying to increase the focus on care quality and transparency, as improved efficiency and greater value is needed if costs of care are to be contained. Understanding these three aspects of cancer care financing can help clarify what Medicare is capable of doing to control the rising costs that are occurring in cancer today.

The Oncology Care Model: Perspectives From the Centers for Medicare & Medicaid Services and Participating Oncology Practices in Academia and the Community

2017 ◽  
pp. 460-466 ◽  
Author(s):  
Ron Kline ◽  
Kerin Adelson ◽  
Jeffrey J. Kirshner ◽  
Larissa M. Strawbridge ◽  
Marsha Devita ◽  
...  
Keyword(s):  
New York ◽  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Cancer Center ◽  
Fee For Service ◽  
Community Practice ◽  
Care Model ◽  
Practice Redesign ◽  
Oncology Care

Cancer care delivery in the United States is often fragmented and inefficient, imposing substantial burdens on patients. Costs of cancer care are rising more rapidly than other specialties, with substantial regional differences in quality and cost. The Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMIS) recently launched the Oncology Care Model (OCM), which uses payment incentives and practice redesign requirements toward the goal of improving quality while controlling costs. As of March 2017, 190 practices were participating, with approximately 3,200 oncologists providing care for approximately 150,000 unique beneficiaries per year (approximately 20% of the Medicare Fee-for-Service population receiving chemotherapy for cancer). This article provides an overview of the program from the CMS perspective, as well as perspectives from two practices implementing OCM: an academic health system (Yale Cancer Center) and a community practice (Hematology Oncology Associates of Central New York). Requirements of OCM, as well as implementation successes, challenges, financial implications, impact on quality, and future visions, are provided from each perspective.

scholarly journals Advancing Value-Based Models for Heart Failure

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Karen Joynt Maddox ◽  
William K. Bleser ◽  
Hannah L. Crook ◽  
Adam J. Nelson ◽  
Marianne Hamilton Lopez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Disease ◽  
Heart Association ◽  
The Elderly ◽  
The United States ◽  
Care Quality ◽  
Fee For Service ◽  
Learning Collaborative ◽  
Longitudinal Models ◽  
Payment Models

Heart failure (HF) is a leading cause of hospitalizations and readmissions in the United States. Particularly among the elderly, its prevalence and costs continue to rise, making it a significant population health issue. Despite tremendous progress in improving HF care and examples of innovation in care redesign, the quality of HF care varies greatly across the country. One major challenge underpinning these issues is the current payment system, which is largely based on fee-for-service reimbursement, leads to uncoordinated, fragmented, and low-quality HF care. While the payment landscape is changing, with an increasing proportion of all healthcare dollars flowing through value-based payment models, no longitudinal models currently focus on chronic HF care. Episode-based payment models for HF hospitalization have yielded limited success and have little ability to prevent early chronic disease from progressing to later stages. The available literature suggests that primary care-based longitudinal payment models have indirectly improved HF care quality and cardiovascular care costs, but these models are not focused on addressing patients’ longitudinal chronic disease needs. This article describes the efforts and vision of the multi-stakeholder Value-Based Models Learning Collaborative of The Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. The Learning Collaborative developed a framework for a HF value-based payment model with a longitudinal focus on disease management (to reduce adverse clinical outcomes and disease progression among patients with stage C HF) and prevention (an optional track to prevent high-risk stage B pre-HF from progressing to stage C). The model is designed to be compatible with prevalent payment models and reforms being implemented today. Barriers to success and strategies for implementation to aid payers, regulators, clinicians, and others in developing a pilot are discussed.

Sustaining the gains in cancer care from the oncology care model.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6632-6632
Author(s):  
Valerie P Csik ◽  
Jared Minetola ◽  
Andrew E. Chapman ◽  
Neal Flomenberg
Keyword(s):  
Cancer Care ◽  
Clinical Pathways ◽  
The United States ◽  
Demonstration Project ◽  
Cancer Center ◽  
Care Model ◽  
Drug Expenditures ◽  
Oncology Care ◽  
Ed Visits ◽  
Feedback Data

6632 Background: The Oncology Care Model (OCM) is a 5-year demonstration project led by the Centers for Medicare and Medicaid Services (CMS) to create a framework for the future of oncology care in the United States. More than half way through the project, our large, urban NCI-designated cancer center chose to focus on and invest in resources and personnel for patient navigation and the development of clinical pathways. Although navigation has shown to reduce emergency department (ED) visits by as much as 6% per quarter compared to non-navigated patients, sustaining it is a challenge because it is a nonbillable service. Clinical pathways are a tool to reduce care variation by addressing drug expenditures, and represent an opportunity to reduce outpatient costs by as much as 35% when patients are treated on pathway.3 Many OCM practices made similar investments and all are facing the question: How will the infrastructure and efforts developed during OCM be sustainable after the demonstration project ends? Methods: An analysis of average ED cost and utilization as well as drug expenditures was conducted using OCM feedback data (Q1-Q8). Total utilization of ED visits and ED admits were used to determine a projected annualized cost which was compared to a budgeted navigation team. Similarly, projected annualized drug expenditures were compared to the annual cost of the pathways tool. Results: We found that ED visits and ED admits would need to be reduced by 11% to cover navigation costs. Similarly, a 0.7% reduction in total drug expenditures would cover the cost of clinical pathways. The OCM data represents a timeframe prior to implementation of these programs and an average increase of 1.6% per quarter for ED admits, a 0.6% decrease in ED visits and 2.7% increase in drug expenditures. This will serve as a baseline to measure progress towards our sustainability targets. Conclusions: Long term sustainability of the infrastructure developed during OCM to support cancer care transformation will be dependent on reducing high cost and highly utilized services. Aligning impact areas with resources/tools to ensure sustainability is an approach that can help define targets for OCM practices.

Assessing the use of low value oncology care following the release of Choosing Wisely guidelines.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18861-e18861
Author(s):  
Alexander Gunn ◽  
Melissa Sarver ◽  
Samantha J Kaplan ◽  
Yousuf Zafar ◽  
Rachel Adams Greenup
Keyword(s):  
Cancer Screening ◽  
Guideline Adherence ◽  
Cancer Care ◽  
Systemic Treatment ◽  
The United States ◽  
Choosing Wisely ◽  
Surveillance Imaging ◽  
Patient Reported ◽  
Oncology Care ◽  
The Impact

e18861 Background: Low -value care contributes to the high costs of cancer treatment. Almost a decade has passed since the American Society of Clinical Oncology (ASCO) Choosing Wisely campaign identified costly diagnostic testing, radiographic imaging, and therapies that are routinely utilized in cancer care despite lacking evidence of benefit. We sought to evaluate the impact of ASCO Choosing Wisely guidelines and to identify barriers to and facilitators of guideline adherence. Methods: A systematic review of published literature from 2012-2021 was performed in accordance with PRISMA guidelines on the trend in use of low value oncology care. All ten of ASCO Choosing Wisely Guidelines were selected for inclusion; these included recommendations focused on cancer screening, staging and surveillance imaging, and systemic treatment and support. The following databases were searched for original research based in the United States: PubMed, CINAHL, Embase, Web of Science, Scopus, and ASCO Meeting abstracts. Eligible studies were examined for information on design, population, and study outcomes, which included guideline adherence and facilitators and barriers to implementation. All citations were independently dual-screened in a blinded fashion by authors (AG, MS). Results: 35 independent studies were identified from 3,590 unique citations and included n = 1,130,216 patients. Data sources captured large claims database analyses (13 studies, n = 1,069,289), institutional studies (14 studies, n = 53,358), patient-reported surveys (2 studies, n = 915), and interventional studies (6 studies, n = 6654). Adherence to ASCO Choosing Wisely guidelines ranged from 13% to 100% overall. Use of low value oncology care varied depending on the area of recommendation, such as cancer screening (44% to 77%), staging and surveillance imaging (30% to 100%), and systemic treatment and support (13% to 100%). Adherence was facilitated by: (a) physician awareness of and education around the recommendations; (b) patient engagement; (c) embedded EHR best practice alerts; (d) guideline alignment with insurance payer requirements; and (e) integrated healthcare systems. Barriers to guideline incorporation included perceived patient anxiety and concerns about patient satisfaction; illness-specific practices; and time needed for patient-provider conversations regarding low value care. Conclusions: Adherence to the ASCO Choosing Wisely guidelines is variable across the cancer care continuum. Health system and policy-level interventions are needed to further reduce the overuse of low value care in oncology.

scholarly journals Surgery and Adjuvant Chemotherapy Use Among Veterans With Colon Cancer: Insights From a California Study

2010 ◽  
Vol 28 (15) ◽  
pp. 2571-2576 ◽  
Author(s):  
Denise M. Hynes ◽  
Elizabeth Tarlov ◽  
Ramon Durazo-Arvizu ◽  
Ruth Perrin ◽  
Qiuying Zhang ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Care ◽  
The United States ◽  
Care Quality ◽  
Stage Iii ◽  
Potential Health ◽  
California Cancer Registry ◽  
Va Hospitals

Purpose US veterans have been shown to be a vulnerable population with high cancer rates, and cancer care quality in Veterans Affairs (VA) hospitals is the focus of a congressionally mandated review. We examined rates of surgery and chemotherapy use among veterans with colon cancer at VA and non-VA facilities in California to gain insight into factors associated with quality of cancer care. Methods A retrospective cohort of incident colon cancer patients from the California Cancer Registry, who were ≥ 66 years old and eligible to use VA and Medicare between 1999 and 2001, were observed for 6 months after diagnosis. Results Among 601 veterans with colon cancer, 72% were initially diagnosed and treated in non-VA facilities. Among veterans with stage I to III cancer, those diagnosed and initially treated in VA facilities experienced similar colectomy rates as those at non-VA facilities. Stage III patients diagnosed and initially treated in VA versus non-VA facilities had similar odds of receiving adjuvant chemotherapy. In both settings, older patients had lower odds of receiving chemotherapy than their younger counterparts even when race and comorbidity were considered (age 76 to 85 years: odds ratio [OR] = 0.18; 95% CI, 0.07 to 0.46; age ≥ 86 years: OR = 0.17; 95% CI, 0.04 to 0.73). Conclusion In California, older veterans with colon cancer used both VA and non-VA facilities for cancer treatment, and odds of receiving cancer-directed surgery and chemotherapy were similar in both systems. Among stage III patients, older age lowered odds of receiving adjuvant chemotherapy in both systems. Further studies should continue to explore potential health system effects on quality of colon cancer care across the United States.

scholarly journals Managed Care & Medical Oncology: The Focus is on Value

2010 ◽  
Vol 8 (Suppl_7) ◽  
pp. S-28-S-37 ◽  
Author(s):  
Elizabeth Danielson ◽  
Jessica DeMartino ◽  
Jill A. Mullen
Keyword(s):  
United States ◽  
Managed Care ◽  
Cancer Care ◽  
The United States ◽  
Emerging Trends ◽  
Oncology Care ◽  
Report Data ◽  
Managed Care Organizations

A previous NCCN Oncology Insights Report™ described the factors making cancer care a priority for managed care organizations (MCOs) and emerging trends in managing costs of cancer care. To better understand the concerns of MCOs and how they are addressing cancer costs and quality, NCCN interviewed senior physician executives from the 3 largest payors in the United States. The interviews provided insights into how these companies managed oncology care, with an emphasis on drugs and biologics. As a follow-up to the previous report, NCCN conducted additional interviews with medical executives from 10 MCOs between February and April 2010. The organizations represented in these interviews were Aetna, BlueCross BlueShield of Minnesota, BlueShield of Michigan, CareFirst BlueCross BlueShield, Empire BlueCross BlueShield, HealthNow, Humana, Independence BlueCross, Priority Health, and UnitedHealthcare. Although this group is diverse, it does not constitute a representative cross-section of MCOs across the United States. NCCN interviewed these executives about the priority of cancer care management for their organizations and the strategies being used to address cost and quality of cancer care. The information garnered from these interviews was qualitative in nature. A separate quantitative analysis of trends in oncology managed care has already been published, and throughout this report, data from the 2009–2010 Genentech Oncology Trend Report are referenced to supplement findings from the NCCN interviews.

Cost, Value, and Financial Hardship in Cancer Care: Implications for Pediatric Oncology

2018 ◽  
pp. 850-860 ◽  
Author(s):  
Susan K. Parsons ◽  
Sharon M. Castellino ◽  
K. Robin Yabroff
Keyword(s):  
Cost Effectiveness ◽  
Pediatric Oncology ◽  
Cancer Care ◽  
The United States ◽  
Financial Hardship ◽  
Therapeutic Approaches ◽  
Care Needs ◽  
Survivors Of Childhood Cancer ◽  
The Cost ◽  
Perfect Storm

Cancer care in the United States faces a perfect storm: an aging population and expected increased cancer incidence, growing numbers of cancer survivors with ongoing care needs, and continued scientific advancements, offering extraordinary promise at extraordinary cost. How, then, do we as pediatric oncologists engage in the dialogue about cancer cost considerations? The purpose of this article and its accompanying session presented at the 2018 ASCO Annual Meeting is to introduce concepts of cost, value, and financial hardship. In the first section, we will provide an overview of principles of health economics, including components of cost, time horizon consideration, discounting, and methods to calculate incremental cost-effectiveness among therapeutic approaches. We will then introduce the value framework being debated in adult oncology and offer potential opportunities for its application in pediatric oncology. In the second section, we will describe the integration of the cost-effectiveness paradigm in an ongoing pediatric clinical trial, including design and analytic considerations. In the third section, we will shift away from cost to the health care system to cost to the patient, which is also termed “financial toxicity” or “financial hardship,” focusing on the ongoing burden of cost on survivors of childhood cancer. Our goal is to provide our readers with the vocabulary and understanding of this complex and often thorny debate so that they can be active participants and informed advocates for their patients.

Do patients with advanced-stage non-small cell lung cancer (AS NSCLC) live longer if managed within a clinical trial setting?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6034-6034
Author(s):  
Taher Abu Hejleh ◽  
Elizabeth A. Chrischilles ◽  
Thorvardur Ragnar Halfdanarson ◽  
Jane F Pendergast ◽  
Dingfeng Jiang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cancer Care ◽  
Survival Benefit ◽  
Hospice Care ◽  
Performance Status ◽  
The United States ◽  
Care Quality ◽  
Baseline Survey ◽  
Multivariate Survival ◽  
Significant Difference

6034 Background: Treatment outcomes of AS NSCLC (stages IIIB and IV) are poor. There is an argument that participation in a clinical trial (CT) may confer survival benefit, probably, through enhancing quality of care. In this study, we explore the survival outcomes and perceived care quality for AS NSCLC patients (pts) treated within vs outside a CT. Methods: Data were obtained from surveys of newly diagnosed AS NSCLC pts studied by the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS), a large cohort of pts across the United States. Pts who did not complete the baseline survey were excluded as this was associated with worse performance status (PS). Baseline characteristics according to CT participation were determined. Association between CT enrollment and survival was explored utilizing univariate and multivariate survival analysis after adjusting for age, comorbidities and self-reported PS. Results: Of 815 AS NSCLC pts, 56 (7%) were enrolled on a CT. Chemotherapy trials comprised 67% of all trials. Of the 815 pts, 697 (86%) died. Median survival for pts within vs outside a CT was 62 vs 64 months. Neither age, comorbidities nor recalled PS differed significantly between pts within vs outside a CT (P=0.2085, 0.5818 and 0.1678 respectively). On the multivariate survival model, CT enrollment did not correlate with longer survival (P=0.8811) and only presence of comorbidities was associated with worse survival (P=0.0021). Comparing pts according to CT enrollment, there was no significant difference in symptom management, receiving hospice care (P=0.606), death location (P=0.2018), or following pts’ wishes (P=0.8321). However, perception of the overall cancer care quality was greater among CT enrollees (P=0.0171). Conclusions: Management of AS NSCLC pts within a CT setting conveyed a perception of superior care that did not translate into survival benefit after adjusting for differences in age, comorbidities, and self-reported PS. These findings suggest that providing cancer care within a CT should not imply a survival benefit when counseling AS NSCLC pts about entering CTs.

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