COMMENTARY

ASCO Takeaways: Business of Medicine

Cary A. Presant, MD

Disclosures

June 14, 2016

Editor's Note: Cary Presant, MD, a practicing oncologist at City of Hope Medical Group and past president of the Association of Community Cancer Centers (ACCC), covered a number of sessions on practice economics at American Society of Clinical Oncology (ASCO) 2016 for Medscape's ASCO 2016 Live Blog, which are excerpted below.

For a review of the most important ASCO 2016 sessions across all topics and tumor types, visit Medscape's ASCO 2016 Live Blog.

The ASCO annual meeting provides oncologists with the opportunity to get the latest recommendations for improving the business aspects of their practices.

This is critical this year because MACRA (Medicare Access and CHIP Reauthorization Act of 2015) and MIPS (Merit-Based Incentive Payment System) represent existential threats to small practices. If you are not in an alternative payment model (APM), you will be in MIPS, which includes quality measures (Physician Quality Reporting System [PQRS]) plus value (resource use, clinical practice improvement) plus meaningful use compliance.

How must we change? What will happen to the financial models we have been using for 40 years—buy-and-bill and fee-for-service? How do we make changes without driving ourselves crazy? And how do we change while maintaining our ability to implement the latest exciting clinical advances presented at the ASCO meeting?

CMS Proposed Rule to Reduce Drug Payments

An ASCO 2016 pre-meeting seminar addressed the economics of cancer care. Discussions focused on cost trends, consolidation, new models for oncology payments, value rather than volume, reforms proposed for drug payments, MACRA and MIPS, and the Oncology Care Model program. While it was a comprehensive overview, presentations were also very granular with many details.

The most immediate challenge we face is the Centers for Medicare & Medicaid Services (CMS) proposed rule to reduce drug payments from "ASP+6%" down to "ASP+2.5%+ a fixed fee of $16.80/drug/day." With the 2% sequester reduction still in place for years to come, this reduces payment to "ASP+0.81%+ a fee of $16.46." This will increase the pressures on all practices, especially small ones, to not administer "under-water" drugs in the office, and to consider administering those agents in the hospital outpatient department.

My recommendation is to carefully look at obtaining drugs with the maximum discount, tasking an administrator to compare drug cost to drug reimbursement monthly for drugs being used, and to network with other oncologists to find workable strategies. State oncology societies can be helpful as well. ASCO currently has general recommendations, but it's less specific advice compared with state societies and consultants. This is not a time to be timid in drug cost oversight by practice leaders.

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