The Patient-Centered Oncology Payment would be defined as an Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act of 2015. The PCOP would offer three payment approaches: basic, consolidated and bundled.
The basic system would provide oncology practices with supplemental payments for treatment planning, care management and clinical trials, and practices would otherwise continue to be paid as they are currently by Medicare. To receive the supplemental payments, practices must meet specific quality requirements.
The consolidated model replaces Evaluation & Management and infusion payments with three new sets of billing codes, reducing 58 current billing codes to less than 12. The consolidated payments are provided monthly based on resources needed throughout the stages of patient treatment.
The bundled payment approach sets a target spending level for services from the oncology practice and hospital admissions, lab tests, imaging and/or drugs.
“With today’s healthcare system in profound transition, it is critically important that payment systems provide medical practices with the flexibility needed to be compensated fairly and adequately, preventing disruption to the care we provide patients and allowing physicians to tailor services to the unique needs of individual patients, without increasing financial burdens on patients,” ASCO’s Clinical Practice Committee Chair Robin Zon, MD, said in a statement.
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