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Hospitals, Health Care Facilities Changing Cancer Payment Approach

Cancer specialists examine future payment models to improve care and lower costs

One of the main goals of the Patient Protection and Affordable Care Act (PPACA) was extending health insurance coverage to more people, but the next phase has arrived: one that looks at how care is delivered and how the high costs associated with care can be curbed, according to an online article in U.S. News & World Report.

Stakeholders are paying attention –– and some have already been exercising solutions that work, the article says. On April 14, the American Cancer Society Action Network, the advocacy branch of the American Cancer Society, held several panels at Washington’s National Press Club led by members of hospitals and other health care systems, who aimed to discuss delivery models that have worked for them.

Increasingly, the payment system for reimbursing health care services is moving from a focus on volume to one of value, in which health care providers must demonstrate that the services they provided helped keep a patient healthy.

One way to do this better is to coordinate care with other providers. Dr. Harvey Hamrick, chief of oncology at Kaiser Permanente in Georgia, said during the panel that doctors notify other specialists within a team of a diagnosis so that work and tests are being done in parallel, rather than one after another. The entire cancer team then meets with the patient and his or her family, and comes up with a plan for care. “[Patients] leave with a big-picture plan for their care,” he said. “They also know the specific next steps.”

Panelists also stressed the importance of keeping data about outcomes. “I can measure my patients, but [without nationwide data] I don’t know how that compares to other areas of the country,” said Dr. John Fox, associate vice president of medical affairs at Priority Health.

With 584,881 deaths a year, cancer is the second-leading cause of death in the U.S. –– just behind heart disease, according to the Centers for Disease Control and Prevention. Still, new findings show that two out of every three people are living 5 years after a cancer diagnosis, making it increasingly a chronic illness and one that health care providers need to continue to manage and monitor.

Although millions more have been covered through private insurance or through Medicaid under the PPACA, Medicare patients could see some of the biggest changes.

Dr. Rahul Rajkumar, acting deputy director at the Centers for Medicare and Medicaid Services, said during the panel session that 1.6 million people are newly diagnosed with cancer every year, and that 50% of those patients are on Medicare. The result is that nearly one in 10 fee-for-service dollars is being spent on treating cancer patients enrolled in Medicare, according to the American Cancer Society Action Network.

Under the current model used at most health care facilities, clinicians have no incentive to curb health care services that may be unnecessary and that may subject patients to repeated tests, potential medical errors, and higher medical bills, the article says.

“There are things that are done in medicine that have no basis in evidence,” Margaret O’Kane, president of the National Committee for Quality Assurance, said in one of the panels. “There are many things in medicine that shouldn’t be happening.”

Medicare spending, like the rest of health care spending, is expected to grow at a faster rate than the rest of the economy as the “baby boomer” generation continues to age into the system and as seniors need more medical care as they age. This growth means that Medicare faces long-term financial stability issues. It already makes up 20% of health care costs, according to the article.

Targeting the program, therefore, would show significant progress toward reducing health care costs. The Department of Health and Human Services, the agency implementing the details of the PPACA, has set a goal of tying 85% of all Medicare fee-for-service to quality or value by 2016, and 90% by 2018.

Panelists throughout the event agreed that one of the ways to provide less costly care while delivering better results is by getting patients involved in decision-making. “If you engage patients to directly participate in the decision-making about their care, they are more satisfied –– including if they are going to die,” said Lillie Shockney, administrative director at Johns Hopkins Breast Center.

She continued by saying that doctors need to understand patients’ goals in order to align medical treatment with their wishes. “I ask the patient, ‘Tell me your life goals.’ Usually the patient will say, ‘Does it matter? Just save my life.’ I tell them it does matter because we want to dovetail those life goals into the treatment plan,” Shockney said.

Most doctors are used to looking at a woman and thinking about fertility preservation and making sure that a woman’s eggs are OK, she says, adding, “But beyond that I don’t think that we really think about asking additional questions.”

She provided the example of one patient who was studying to become a concert pianist. When Shockney learned this, she told her doctor to keep her away, if possible, from treatments that might cause numbness and pain in her fingers.

“I take a lot of pride in helping orchestrate [their goals] with them,” she said.

Source: U.S. News & World Report; April 15, 2015.


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