CMS Fee Schedule Changes Signal Move Towards Value-Based Care and Bundled Payment Models
Annual Oncology summit will explore how emerging payment schema can be transposed to specialty care
The proposal by Centers for Medicare and Medicaid Services (CMS) for a reduction in physician fee schedules for 2014 of 20.1% clearly signals that the move towards cost-effective and value-based primary and specialty care in the USA remains a strong focus.
Conversely outpatient prospective payment system (OPPS) rates will increase by 1.7% in order to increase quality of care over quantity of services provided. Five additional categories of items and supporting services to be bundled together for payment have been added by the rule, indicating that the use of bundled payments in serious, expensive disease areas such as oncology could become commonplace over the next few years.
“Value-based purchasing places pressures on hospitals and physicians to eliminate redundant or inappropriate care,” explains Joel Brill, Chief Medical Director at Arizona’s Predictive Health, and Lead Physician on the American Gastroenterological Association Colonoscopy Bundle Project, which sought to develop a bundled payment methodology for easy adoption by GI physicians and ambulatory surgery centers as they contract with health plans, marketplaces, employers and accountable care organizations. “Bundled payments are a response to this. Payers and purchasers are pushing providers towards these bundled services that define quality and efficiency. Instead of ‘how much did you do’, value-based cancer care moves us towards ‘how well did the patient do’.”
Brill notes that “bundles coordinate care across settings and providers to effectively manage diseases and populations – it’s about setting a framework for engaging consumers.” Futhermore, Brill explains that the emerging model of bundled care provides strong incentives for pharmaceutical manufacturers. “It’s an opportunity for manufacturers to adopt a collaborative approach to demonstrate impact on clinical and financial outcomes, as well as to support effective patient management through the adoption of clinical best practices and decision-making tools”.
Dr. Brill will speak at Oncology USA 2014, held in Boston on March 25th and 26th, on the lessons bundled care can give to big oncology manufacturers and providers . He’ll be joined by other trailblazing physicians such as Dr. John Sprandio, the thought leader behind the Oncology Patient-Centered Medical Homes, as well as representatives from emerging specialty ACOs – including John Lynch of the Connecticut Center for Primary Care and Johnathan Lancaster, President of Moffitt Cancer Center in Florida.
Various oncology thought leaders from the industry will also join in the debate at the conference, including Byran Litton of Eli Lilly, Jeremy Leffler of Sanofi and Suraj Moorthy of EMD Serono.
About Oncology USA 2014
Now in its 5th year, this two-day conference will aim to build bridges and forge strong partnerships between payers, providers and pharma, all the while focusing on the most crucial stakeholder: the oncology patient. Find out more at the official website.
Register before January 30th via the secure link below to take advantage of a $300 saving on all conference passes: https://secure.eyeforpharma.com/oncologyusa/register.php
Aidan Brain
Head of Oncology | eyeforpharma
T: +44 (0) 207 375 7513
E: abrain@eyeforpharma.com