Although CMS has introduced a strict timeline to move to value-based payments, its new Oncology Care Model is partially relying on fee-for-service, and that's a good thing in the case of oncology, said Ira Klein, MD, MBA, senior director of quality, Strategic Customer Group at The Janssen Pharmaceutical Companies of Johnson & Johnson.
Although CMS has introduced a strict timeline to move to value-based payments, its new Oncology Care Model is partially relying on fee-for-service, and that's a good thing in the case of oncology, said Ira Klein, MD, MBA, senior director of quality, Strategic Customer Group at The Janssen Pharmaceutical Companies of Johnson & Johnson.
Transcript (slightly modified for readability)
What are your thoughts on the fact that the Oncology Care Model continues to rely on fee-for-service payment?
I think that the idea that oncology care is fee-for-service is a little bit of a misnomer. Because while it has been a system that pays oncologists a professional fee and that's volume-based—the more patients, the more professional fee that you get, and that's the same for the drugs: they buy the drugs, they keep them in the inventory and then those drugs are administered in an infusion-center environment and billed out at varying rates—that's not the fee-for-service environment that almost all other practitioners have. It's not the model of pure cognitive specialists and it's not the model of strictly procedural-oriented specialists. It's kind of a blend.
Fee-for-service in oncology was always a little bit different. And this model acknowledges that the practices need to have a revenue stream to support their infusion centers—that's part of the acces issues that need to be understood; those actions need to be financially supported. The model also acknowledges that we need to move to some value-based arrangements and that's where the monthly fee comes in—$160 per month for the duration of the episode—and the need to exchange information about the quality metrics.
So I think that this care model understands that fee-for-service was not really straightforward fee-for-service before. It actually was a blend of several services in order to support the viability of the infusion centers and so by keeping up some portion of the fee-for-service, they're continuing to acknowledge that we need those infusion centers to be available in the office setting to provide access to patients. And as we migrate portions of the entire episode over to value-based we still can't forget about paying the bills every month. And this is part of that function.
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
What We’re Reading: FDA Approves UTI Antibiotic; Ozempic, Wegovy Price Investigation; US Births Fall
April 25th 2024The FDA recently approved an antibiotic for the treatment of urinary tract infections (UTIs) in women; a Senate committee recently launched an investigation into the prices of Novo Nordisk’s diabetes and weight loss drugs; US births fell last year, resuming a national slide after a previous increase during the pandemic.
Read More
Empowering Community Health Through Wellness and Faith
April 23rd 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In the third episode, Camille Clarke-Smith, EdD, MS, CHES, CPT, discusses approaching community health holistically through spiritual and community engagement.
Listen
Dr Dalia Rotstein: Physicians Must Be Aware MS Affects People of All Backgrounds
April 24th 2024Dalia Rotstein, MD, MPH, emphazises the importance of awareness that multiple sclerosis (MS) impacts patients from various backgrounds as clinicians think through ways to improve access to care and research efforts in MS.
Read More
The Federal Trade Commission's (FTC's) vote to ban most employers from issuing and enforcing noncompete clauses could have varying impacts on the health care workforce; federal regulators vastly under-enforced antitrust laws in the hospital sector during the last 2 decades, resulting in increased health costs; the FDA recently found genetic evidence of the H5N1 bird flu virus in pasteurized commercially purchased milk.
Read More