Bundle up: Oncology should prep for new reimbursement models

Bundled payments may offer more revenue opportunities for practices or bring headaches and concerns, but either way, practices should take a close look at their processes to find ways to streamline, according to an article published in the April issue of The American Journal of Managed Care.

In oncology, bundled payments would mean a set amount of money per patient paid to the oncologist to cover all costs from initial visit to discharge, explained Kurt Ullman, freelance healthcare writer.

The cause for concern is that cancer care is very individualized, with enough variation from patient-to-patient to make bundled payments problematic, according to Ullman.

He suggested a better payment fit for oncologists would be the episode of care model, where some risk is transferred to oncologists, but not all. In one example provided by Ullman, an oncology group is paid fee-for-service for office visits and medications, which are reimbursed at the average sale price, which incentivizes in-office treatment.

Because of the shift in payments, Ullman wrote that it’s important for practices to streamline and implement guidelines from the National Comprehensive Cancer Network or other professional associations. Up-to-date health IT and efficient business management, coding and billing also will be key.

“These systems help analyze costs, an important part of the process when negotiating your fee and managing your costs,” wrote Ullman.

For more on how the specialty is responding to changing reimbursement models, check out the Health Imaging cover story for May/June titled “The New Economics of Radiation Oncology.”