ASCO’s Model for Cancer Payment Reform

In May, the American Society of Clinical Oncology (ASCO) released a proposal to significantly improve the quality and affordability of care for cancer patients. Expanding on a payment model circulated last year, ASCO’s proposal would fundamentally restructure the way oncologists are paid for cancer care by providing sufficient payment to support the full range of services that cancer patients need.

It would also remove barriers created by the current payment system to delivering high-quality, affordable care.

Blase Polite, MD, assistant professor of medicine at the University of Chicago and immediate past chair of ASCO’s Government Relations Committee, says the model is intended to provide payment for the complex and important services in cancer care. ASCO’s payment plan includes four new supplemental payments:

  • $750 for new patient treatment planning
  • $200 per month per patient for case management
  • $50 per month for each patient during active monitoring
  • $100 per month per patient for participation in clinical trials

ASCO says that spending would decrease because oncologists would accept accountability in four areas:

  • Avoiding emergency department visits and hospital admissions for complications
  • Appropriate use of drugs, lab testing, and imaging studies
  • Management of end-of-life care
  • An ongoing commitment to ASCO standards of quality

Polite says that the trouble with the OCM is that it doesn’t reward doing the right thing and that Medicare takes a 4% deduction off of the top of the benchmark cost of each episode, which places immediate pressure on oncologists to somehow reduce spending.

He says that the benchmark costs for successive years continue to be lower, a phenomenon that does not properly reward physicians for reducing expenditures. The better approach, he says, is to reward physicians for providing high-quality care and controlling costs.