Barbara McAneny, MD, CEO of New Mexico Oncology Hematology Consultants, gives her insight on the potential pitfalls of bundled payment plans in oncology and how they could potentially work.
Barbara McAneny, MD, CEO of New Mexico Oncology Hematology Consultants and former president of the American Medical Association, gives her insight on the potential pitfalls of bundled payment plans in oncology and how they could potentially work.
The early version of Oncology Care First was a step toward bundled payments in medical oncology. Do you see this happening?
So, we have inaccurate targets. So let's bundle up all those inaccurate targets—and I don't know that the patients, the volume, the type of cancers, and the types of comorbidities I saw last month are going to be the same as what I see this month. But let's take the ones I saw last month, let's bundle it all together, let's pay it to me in advance, and good luck with that.
That's best what I can figure out what Oncology Care First is trying to do. And then they dangle that they want to do something with patient reported outcomes, which I don't know what they're wanting to do. I will tell you that this is one of the reasons that I wrote MASON, which stands for Making Accountable, Sustainable Oncology Networks, which uses a group of practices called National Cancer Care Alliance to provide clinical data, pulls the claims data and puts the two together so we can figure out that this expensive colon cancer patient was because they had peritoneal metastasis and needed bowel obstruction resections; and this other one just had liver metastasis, so they only had chemotherapy infusion costs.
If we can figure out an accurate target and take the time to use data science to create accurate targets, then I would be willing to accept a case rate type of bundle, that if you get a person with this case, you know this is their target, and see if you can beat that target. That would go to transactional risk. And in MASON, I would pull the drugs out, I would take the drug margin, kind of like United and other commercial payers are doing, and recognize that that's what we use to build our infusion centers and pay our infusion nurses and do everything else we have to do. If we didn't have the drug margin, independent practices would shrivel up and die. So we need to have that amount of money contributed to the upkeep of the practice in terms of the infusion costs, etc., so that we can manage these patients. And I think if we can take the drugs out of the risk part, that gets rid of the question of, “Am I disadvantaging my patient by giving them the expectative drug or myself and my practice by giving them the most effective drug? which is again, that's a Sophie's Choice. We shouldn't be there.