Bundled Payments in Oncology: What Do Payers Think?

Scott Gottlieb, MD, acknowledged that hospitals have not traditionally been innovative in terms of service, but that they have been able to adopt innovations rapidly. It’s just that these innovations have come from other places.

John L. Fox, MD, MHA, emphasized his preferences for accountable care organizations (ACOs) due to their purpose of taking accountability for the management of the health of a population. In his eyes, the point of a bundle is undermined. “Where bundles, I think, work best is where there isn’t a lot of preference sensitive or physician-driven utilization… I think those make perfect sense because you can still manage the health of that isolated population without a lot of demand-driven use,” Dr Fox stated.

Dr Gottlieb also wants to push oncology bundles where it might make sense to do so; however, while Dr Patel thought bundling is possible for oncologists, but that it will take time to implement.

Ted Okon said that while there are areas where bundling makes sense—like with MD Anderson’s head and neck bundles—Medicare doesn’t view it as such. The Medicare side is usually black-and-white, and they don’t’ have the ability to selectively bundle, Okon said. With cancer, you would need to create a bundle for every type and iteration and he doesn’t see that as happening anytime soon.

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