Oncology group proposes new payment model with ramifications for radiology

The American Society of Clinical Oncology (ASCO) is proposing an alternative payment model under the Medicare Access and CHIP Reauthorization Act of 2015, and it includes a bundled option that would set a target spending level for imaging services.

The group announced May 21 that its Patient-Centered Oncology Payment (PCOP) would, in its basic version, augment current Medicare reimbursement with four supplemental, non-visit-based payments to support diagnosis, treatment planning and care management. To qualify for the added compensation, oncology practices would need to meet various quality criteria. These include showing appropriate use of imaging and lab studies.

The PCOP proposal offers two options to the basic model.

A consolidated payment system would replace 58 existing billing codes with fewer than a dozen, simplifying processes so as to more easily match payments with resources needed at various stages of the patient’s treatment.

The aforementioned bundled option would set a capitated dollar amount to cover not only the oncology practice’s services but also, potentially, hospital admissions, imaging studies, laboratory tests and drugs. Oncology practices selecting this option “would have greater flexibility to redesign the way they deliver care to patients without the restrictions” imposed by fee-for-service payment models, according to ASCO.

“With today’s healthcare system in profound transition, it is critically important that payment systems provide medical practices with the flexibility needed to be compensated fairly and adequately, preventing disruption to the care we provide patients and allowing physicians to tailor services to the unique needs of individual patients, without increasing financial burdens on patients,” said Robin Zon, MD, ASCO’s clinical practice committee chair.

For additional details on the proposal, click here