Physician payment reform matters to cancer patients

Why should patients care about how physicians are paid? Because the way we as a country, and Medicare as the largest payer, compensate physicians directly affects the care patients receive.

Changes to the way physicians are paid are on the horizon, as our current system is not sustainable for physicians, patients, or taxpayers. Patients must have a voice in debates about Medicare payment and the way health care is reimbursed. We must stand up for reforms that will improve the quality of care patients receive, including incentives for actively involving patients in decision-making and improving coordination of care. To enact real change, we have to acknowledge that overutilization of health care is a real problem, even in the cancer care system, and at the same protect against incentives for under treatment by insisting on quality measurement.

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The outlook for significant payment reform recently became more positive with the release by the House Ways and Means Committee and Senate Finance Committee of a document that describes a major legislative initiative – “a bicameral, bipartisan effort” – to overhaul Medicare physician payment.  The package would repeal the sustainable growth rate (SGR) formula, forever ending the disruptions caused by threatened payment reductions of 10, 20, or 25 percent annually as the result of application of the current SGR formula.  That is a clear progress indeed. 

In addition, the legislation provides financial incentives to health professionals to focus on delivering high quality care instead of high volume of services.  Payment incentives would be available through a value-based performance payment program that would emphasize quality measurement and clinical improvement activities.  Those improvement activities – rewarded with incentive payments -- include the combination of care planning and care coordination of care that is key to better cancer care.

As advocates for better quality cancer care, we have encouraged Medicare payments to physicians and other health professionals to develop and communicate detailed plans of care to their cancer patients and also to provide treatment summaries and survivorship plans at the end of active treatment.  The care planning process will foster better treatment decisions and encourage more aggressive coordination of care, things that are good for the individual cancer patient and also for the Medicare program. 

Why is this so important to cancer patients? Consider the breast cancer survivor who recalls that her treatment experience was isolating and scary because she had so little information about what her treatment would be like and how to manage visits with multiple providers who did not talk to each other about her care. Or the man newly diagnosed with prostate cancer who faces complicated treatment options –including “watchful waiting” – and needs more information and time to make his decision. Or the long-time cancer survivor who needs a detailed summary of the treatment she has had over many years in order to make decisions for the future. These individuals need and deserve better planning and coordination of their care.

In addition to beneficiary engagement and care coordination, the committees also provide incentives to physicians to design and participate in alternative payment models.  Physicians and other health professionals – including innovators in cancer care -- have already begun experimenting with alternative delivery and payment systems. The proposal establishes a pathway for rewarding innovators and encouraging more to join them in new models for delivery of higher quality care.

Of course, the devil is in the details of this groundbreaking payment reform package, and those details have yet to be released.  Some health professionals will likely balk at the prospect of such aggressive change and some patients will have concerns about incentives for underutilization of services as we move away from volume-based care.

I am hopeful that the details of the package can be ironed out and a truly patient-centered, quality-driven payment system can advance. We’ve waited too long to tackle these issues already, and there is no more time to waste.

Fuld Nasso is the CEO of the National Coalition for Cancer Survivorship, which advocates for quality cancer care for all people touched by cancer.