Analysis shows that cost, quality of care, and survival rates are better under bundled payment models.
This article first appeared June 01, 2017 on Medpage Today.
By Matt Wynn
The fee-for-service model of cancer care is a major driver of waste, "creating perverse incentives to provide high-cost, low-value care without sufficiently monitoring quality," Ethan Basch, MD, writes in the latest issue of JAMA Oncology. Basch is director of the Cancer Outcomes Research Program at the University of North Carolina-Chapel Hill School of Medicine.
One solution, he argues, might be to adopt a model like that explored in a study published in March, also in JAMA Oncology, by C. Jason Wang, MD, and colleagues. That study used data from Taiwan to examine how cancer patients fared for 5 years. Some patients were treated under the country's bundled payment program, which pays hospitals for each newly diagnosed breast cancer based on stage-specific, guideline-recommended treatment costs. Others were treated at non-participating hospitals, which used a traditional fee-for-service payment method.
The results give strong evidence to finding alternative funding models, Basch writes. Event-free survival for women with nonmetastatic disease was almost 5% better in the bundled payment group at 5 years. Care was also more likely to adhere to quality standards, and costs were lower. Whether looking at cost containment, outcomes, or quality care adherence, the bundled payment system represented an improvement.
While not quite an apples-to-apples comparison, the findings indicate that the CMS Innovations Center's new Oncology Care Model (OCM) should improve care in the U.S., too.
Basch said that he is hopeful that the OCM is the first step toward a more sane payment system for cancer care.
"The United States must do more to improve quality and slow the increasing cost of care," he wrote. "In the past, the field of oncology was slow to experiment with new approaches, but that can no longer be the case."