Potential approaches to sustainable, long-lasting payment reform in oncology

With unsustainable and rising health care costs reaching what are regularly termed crisis levels, the United States' current fragmented and inefficient health care system is in need of reforms that will allow oncology practices to adapt to changing delivery systems that put the patient at the center of care. Oncology accounts for roughly 10% of all health care costs and is a prime target for reform-minded stakeholders, particularly in the realm of reimbursement for care. ASCO believes that successful physician payment reform will be physician led and driven. This article was developed by the ASCO Clinical Practice Committee Payment Reform Workgroup and underwent subsequent review and approval by the full Clinical Practice Committee and the ASCO Board of Directors. The following represents an abridged version of the original document, edited for length. The entire document may be found at www.asco.org/paymentreform. It includes a critical survey of the current reimbursement landscape and lays out the foundation for a comprehensive, multifaceted solution that would replace the current fee for service structure. This foundation includes quality measurements and incentives, a replacement for the current "buy and bill" system for chemotherapy drugs, value-based pathways, episodic or bundled care payments, and care coordination to decrease use of expensive resources. ASCO intends to pursue further development, modeling, and testing of these concepts and invites others in the oncology community to prepare to lead efforts to a more rational and stable payment plan that will support high-quality care for our patients.