Implications of Bundled Payments in Oncology

The panelists discussed Medicare’s push towards bundled payments and what that would look like in the field of oncology.

Kavita Patel, MD, MS, said that there is already some exploration in bundling payments in cancer care because there is a prevailing notion that bundle payments can solve everything. But that’s not easy to implement with oncology, she pointed out. There are some cases that make sense with bundling, such as radiation oncology. As of right now, however, Medicare is only trying to do some pilots, essentially a patient-centered oncology home with some shared savings components, because CMS wants to try something new with payment models. But Dr Patel does not expect Medicare to mandate a bundle anytime soon.

Ted Okon agreed that bundling cancer is a difficult task. “It’s not the same as dialysis. We are talking about 254 different types of cancer, you have all of these combinations,” he stated. Medicare might be able to bundle some of the top cancers, but he said that would occur in the distant future. The CMS Oncology Care Model is currently trying to create a bundle without the drug, and bringing in the administration because it doesn’t have access to private payer data.

Scott Gottlieb, MD, took a different stance saying, “My view is that it's going to be so administratively difficult for them to try to engage in some kind of reassuring arrangement outside of a bundles arrangement that they are going to default to that. They know how to transfer risks but they don't know how to measure outcome.”

Dr Patel said that Dr Gottlieb was not wrong, especially when looking at what a hard time orthopedics has had with bundling. Although mandatory, orthopedists have had to delay the launching of the Comprehensive Care for Joint Replacement Model from January to April. Even for a well-constructed bundle, there has been an implementation delay, but she viewed it as a result of Medicare as an evolving process. “How much are we also fundamentally changing the Medicare program through this process?” Dr Patel asked.

Okon indicated that oncology would be willing to contemplate the bundling process simply because the current reimbursement system isn’t working. Hospitals do not have the incentive to get innovative, and he believes that innovation will only happen within the community space.