Letter | Time to change nation’s cancer payment model to focus on quality, not quantity

Despite years of progress, cancer remains the second most common cause of death in the United States, accounting for the loss of nearly one in four Americans. This means that - even in the year 2015 -more than 1,600 cancer patients will die each day, according to the American Cancer Society.

As a radiation oncologist providing quality, state-of-the-art cancer care to the Myrtle Beach community and the coastal region, I have dedicated my career to the individuals who represent such chilling statistics. And with the help of many colleagues, I am proud to work each day with patients and families battling such a grueling, indiscriminate disease.

While as physicians we can’t always prevent cancer, we do have the ability to help ensure that all patients are receiving the most effective and clinically appropriate treatments following diagnosis. However, one principal barrier currently impedes many oncologists wholeheartedly attempting to fulfill this goal: outdated payment models.

Today, many private and public payers operate under a fee-for-service payment model, which reimburses doctors for the number of services provided. However, at my own practice, and other 21st Century Oncology practices around the country, we’ve chosen to implement a physician-developed “bundled” payment model for radiation oncology that supports the delivery of value-based care.

This “bundled” payment model allows insurers to pay a set amount for a full course of care based on the patient’s specific condition, allowing us to provide a diverse range of radiation services for those battling cancer. In turn, our payment model gives doctors the freedom to dictate clinically advanced, personalized treatment paths. It also makes sure that patients receive only the services they need and that have been proven to work against their cancer.

As a result, patients often experience better outcomes and a greater satisfaction with their care.

In the same breath, our value-based payment model has paid dividends for payers across the health delivery system. Under a “bundled” payment model, insurers – private and public – no longer need to worry about oncologists delivering clinically unnecessary care to patients. Simply speaking, the incentive for doctors to provide needless services – a problem frequently sited under fee-for-service payment models – is entirely removed.

Most importantly, though, patients receive a higher quality of care that’s specific to their condition with fewer visits to the physician’s office, which is exactly what we should be striving for as policy makers, physicians and insurers work together to strengthen our nation’s healthcare delivery system.

This successful, physician-created “bundled” payment model has started with offices like my own. However, we now need a broad-based approach to ensure that this type of fiscally sound policy creates a higher quality of care for all cancer patients in the U.S. To do so, lawmakers in Congress should examine, understand and support the work we are doing by advocating for payment stability, which bolsters care and sustains inventive payment models like ours.

The last few decades of biomedical research have produced groundbreaking tools to battle cancer. And in many ways, technological advancements – as well as the new treatments it generates – are our best chance of defeating cancer in the years to come. The best way to bolster the quality of cancer care in the short-run is through investment in innovative

payment models.

However, this is also something for which oncologists and cancer researchers have limited control. Rather, the establishment of stable funding for updated oncology payment models is only made possible by policy makers. Thus, in order to truly reform the cancer care delivery system for the benefit of vulnerable cancer patients, it is imperative that our nation’s lawmakers take action.

Cancer has impacted us all in some way, whether it’s through family, friends, or a deeply personal struggle with the disease. Cancer isn’t waiting to strike, and neither should Congress.

Cancer patients can’t wait another day; they don’t have the option.

The writer is Medical Director of Carolina Regional Cancer Center.

This story was originally published July 13, 2015 at 11:53 AM with the headline "Letter | Time to change nation’s cancer payment model to focus on quality, not quantity."