Can cancer care be less costly?

By: Liv Osby

From: greenvilleonline.com

Treating cancer is expensive.

Medical costs alone are expected to top $158 billion in 2020, a 27 percent jump over a decade, according to the National Institutes of Health.

But more than 1.6 million people will be diagnosed with cancer this year. And they need chemotherapy and radiation and tests and drugs.

So can anything be done to reduce the cost of that treatment? The Center for Medicare and Medicaid Services plans to find out.

This month, CMS launched a pilot project that federal health officials hope will save Medicare about $500 million, all while improving care.

The project focuses on standardizing care and moving from a basic fee-for-service payment system to one that offers more value and eliminates redundancies, such as unnecessary X-rays or lab work, said Dr. Robert Siegel, director of oncology at Bon Secours St. Francis Health System, which is one of nearly 200 providers nationwide participating.

For instance, he said, as long as the side-effect profile and efficacy of a less expensive drug is the same as a costlier one, it makes sense to choose the one that costs the least.

But that’s not typically done because most physicians don’t know how much the drugs cost and don’t spend precious time learning about it, he said.

“The issue of being cost-effective and providing quality are not necessarily mutually exclusive,” he said. “This is an effort to bring those together.”

Better care

Medicare is leading the effort because almost seven in 10 cancers occur in people 55 and older, according to the American Association for Cancer Research.

Health and Human Services Secretary Sylvia M. Burwell said the new model encourages greater collaboration and information sharing so patients get the care they need when they need it.

“This patient-centered care model fits within the Administration’s dual missions for delivery system reform and the White House Cancer Moonshot Task Force,” she said, “to improve patient access to and the quality of health care while spending dollars more wisely.”

Called the Oncology Care Model, the program challenges providers to demonstrate a 4-percent reduction in cost over the next 18 months, said Terra Dillard-Spann, administrative director of oncology services at Bon Secours St. Francis Cancer Center.

If achieved, that could mean a savings of $400,000 in the cost of oncology care at St. Francis annually, she said.

Some of the cost of cancer care – and health care in general – comes from lack of coordination, Dillard-Spann said. The project will enhance coordination by having one central hub managing care, providing direction on the front end and working more closely with supportive services, she said.

More than 3,200 oncologists and 155,000 Medicare beneficiaries nationwide will be participating in the program, which runs through June 30, 2021.

Greenville Health System is participating as well.

“Our vision at Greenville Health System is to transform health care for the benefit of the people and communities we serve,” said Dr. Larry Gluck, medical director of GHS’ Cancer Institute. “This new care delivery model aligns well with our vision and will help us transform cancer care for patients both now and in the future.”

Quality vs quantity

The program is aimed at moving Medicare – and the nation’s health care system – toward paying for the quality of care instead of quantity, thereby improving health outcomes at the same or lower cost. CMS hopes the financial incentives will help do that.

During the pilot, participants will get regular Medicare fee-for-service payments, plus a monthly payment of $160 per patient for enhanced services and care coordination.

Providers will follow recognized clinical guidelines with an emphasis on person-centered care and enhanced services such as coordinating appointments within and outside the oncology practice to ensure timely delivery of diagnostic and treatment services; 24/7 access to care when needed; ensuring that test results come in before appointments so additional visits aren’t necessary; and offering access to other resources such as support groups, pain management services and clinical trials.

St. Francis has a number of initiatives underway looking at cost containment because the nation is moving to a value-based payment system, Dillard-Spann said.

“We firmly believe that it is necessary and vital to continuously seek ways to reduce the cost of health care not only for the nation, but our organization and for patients,” she said. “The other thing is that this is the direction health care is going in the future. By 2018, 50 percent of oncologists will be under some sort of alternative payment model. We wanted to be part of something we could guide and direct.”

But it’s a gamble, Siegel said.

“In essense, they’re paying us an additional … fee so that we’ll be more actively managing a patient’s care with the hope and presumption that there will be some savings at the end of it,” he said. “If that doesn’t happen, there will be no savings and CMS will be paying twice.”

Then, he said, providers could be forced into more draconian cost-cutting measures by CMS.

Honest conversations

Patients have the option of participating in the new care model or not, Dillard-Spann said.

And while there’s no current estimate of potential savings to patients, CMS plans to monitor the impact on beneficiary out-of-pocket spending.

In addition, providers must prove that they’re offering quality care.

“With programs like this we do have the potential to create a new tension that didn’t exist before – the same physician who is caring for me is also concerned about the cost of my care. Might he be altering what’s best for me because of the cost constraints?” Siegel said.

“Those are things we are going to have to deal with … and have an open and honest conversation about cancer care and what is useful and what is not,” he added. “We hope the whole issue doesn’t turn into a conflict between economics and care, which it shouldn’t. But the perception wil be there. And it will be on us to disavow that whole notion.”

Siegel said the new approach should hold true for other diseases as well, but that CMS chose to begin with oncology because it’s so expensive.

He also hopes that by being better stewards, providers can force some downward pressure on the price of cancer drugs, which can cost many thousands of dollars and force patients into financial jeopardy.

“If we as providers are being cautious about how we spend the health care dollar,” he said, “then perhaps – if our federal government cannot or will not negotiate with pharmaceutical companies – perhaps the behavior of provider will have some dent on what these drugs cost.”