Medicare Considers Using NCCN Guides as Clinical Pathways

Nick Mulcahy

April 10, 2014

The Centers for Medicare and Medicaid Services (CMS) are reviewing a proposal from a major consulting company to use oncology clinical pathways in a pilot program designed to control costs and promote more uniform medical practice, according to a report published in a trade publication.

A substantial portion of the proposed clinical pathways comes from the National Cancer Center Network (NCCN) oncology guidelines, and the pathways were developed in conjunction with that organization.

Other clinical pathways programs are already in use by individual practices, state oncology societies, integrated delivery networks, and private payors such CareFirst BlueCross BlueShield, as reported by Medscape Medical News.

However, they are not used by America's biggest payer — CMS.

If the proposal is accepted, CMS could roll out a pilot project in select oncology practices and hospitals sometime in 2014, according to an official from the consulting company, McKesson Specialty Health, quoted in a report in Evidence-Based Oncology.

The report notes that Medicare spent $34.4 billion for cancer care in 2011, which represents 10% of its total fee-for-service payments for that year.

The idea behind pathways is to eliminate unnecessary medical interventions and promote the most cost-effective treatments to enhance care and reduce costs.

Last year, oncology guidelines expert Gary H. Lyman, MD, MPH, told Medscape Medical News that using pathways "makes intuitive sense." However, he pointed out that there is a lack of evidence showing the impact of guidelines and their use on clinical practice and patient outcomes.

"Until recently, the only evidence of utilization has been how frequently they are accessed," said Dr. Lyman, who is codirector of the Hutchinson Institute for Cancer Outcomes Research and professor of medicine, public health, and pharmacy at the University of Washington School of Medicine in Seattle.

The oncology clinical pathways proposal being considered by CMS is the byproduct of a collaboration between the NCCN, the US Oncology Network, and McKesson, according to a McKesson press statement.

On a practical level, the pathways are contained in "workflow-integrated software" that allows "physicians to access treatment options consistent with evidence-based standards at the point of care," according to McKesson.

NCCN Clinical Practice Guidelines in Oncology serve as the "foundational evidence source" for the collaborative pathways. The pathways are built on an already established oncology pathway product from US Oncology, according to the company.

Evidence-based clinical pathways might be able to reduce overall spending on cancer care, according to a study presented last year at the annual meeting of the American Society of Clinical Oncologists (ASCO), and reported at that time by Medscape Medical News.

An oncology pathways program could save about 15% on cancer-related costs and reduce hospital admissions by about 7%, said researchers, who analyzed a pathways program at CareFirst BlueCross BlueShield, which serves Maryland, the District of Columbia, and portions of Virginia.

In August 2008, the large insurer partnered with Cardinal Health Specialty Solutions to launch the first cancer clinical pathway in the United States.

For pathways to be successful, "physicians will have to walk the walk, not just talk the talk," said a Cardinal official at the ASCO meeting.

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