Dec 15, 2015
ASCO has called for comprehensive physician payment reform to support the full scope of services required by patients with cancer, rather than jeopardizing patient outcomes by reducing the available resources in a particular cancer care setting in an effort to achieve “site neutrality” in reimbursement for oncology services. In a policy statement published in October 2015 in the Journal of Clinical Oncology (JCO), ASCO asserts that the traditional approach to physician payment under Medicare is flawed and reflects a narrow and outdated view of the needs of individuals with cancer and the best available options for delivering highquality, high-value care.
According to ASCO’s Policy Statement on Site-Neutral Payments in Oncology, current discussions on site neutrality—the concept of providing equal reimbursement for the same services delivered in any care setting— have centered on a flawed comparison between outpatient cancer treatment settings. ASCO contends that there is no basis to conclude that the reimbursement levels developed for oncology services under the two dominant Medicare reimbursement methodologies for outpatient oncology services—the Medicare Physician Fee Schedule (MPFS) and the Hospital Outpatient Prospective Payment System (HOPPS)—should be substituted for one another. The two Medicare reimbursement systems, one for the physician office setting (MPFS) and one for the hospital outpatient setting (HOPPS), are based on different data sets for rate setting.
The differences between MPFS and HOPPS are further exacerbated, in ASCO’s view, by separate conversion factors established by the Centers for Medicare & Medicaid Services under rules that are unique to each care setting. The conversion factors for the two settings are established in different ways that have little relationship to each other or to the actual cost of providing oncology care to Medicare beneficiaries, as they are based on the aggregate amount of Medicare funding allocated for each setting of care for a particular year.
A number of stakeholder groups are working to improve cancer care by developing alternative models for coding and reimbursing oncology services under Medicare. Models developed by ASCO, the Center for Medicare & Medicaid Innovation, and other groups are designed to transform the outdated Medicare oncology coding and reimbursement systems by establishing episode-based or bundled payments that include coverage and adequate reimbursement for the many critical cancer care services that are unrecognized, uncompensated, or undercompensated under the current system. An expanded set of professional services will promote efficiency and reduce unplanned hospitalizations and emergency room visits, ASCO noted. By providing adequate resources to oncology practices for the full scope of medically necessary services, these new models take a patient-centered approach to promoting value and improving patient outcomes, with the promise of lower aggregate Medicare expenditures.