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Healthcare Law Means Big Changes—and Some More of the Same—for Oncology

The new healthcare reform law promises big changes for all of medicine, oncology included. Patients newly covered by private insurance means better reimbursement and new initiatives to drive value may transform the way oncology care is delivered and paid for in the long run. Yet, the Patient Protection and Affordable Care Act does not address many of the most pressing issues for oncology.

The Transformation of Healthcare in Private Practice Oncology
A Roundtable Discussion with

Mark J. Krasna, MD Medical Director, St. Joseph Cancer Institute; Editor-in-Chief, Journal of Multidisciplinary Cancer Care Ronald Barkley, MS, JD US Oncology; Cofounder, Cancer Center Business Summit Michael L. Blau, JD Partner and Chair, Health Care Venture Practice, Foley & Lardner LLP; Cofounder, Cancer Center Business Summit Jessica Turgon Senior Manager, ECG Management Consultants, Inc   

Oncology Drug Coding and Reimbursement

The essential element of full reimbursement is proper coding. Without the proper codes, payers will not compensate oncology practices for the drugs and services they provide during the course of patient care. It is important to remember that coding is about more than just the drugs used; coding involves all the aspects of treating a patient—diagnosis codes, drug codes, procedure codes, and even administrative codes. In an interview with the Journal of Multidisciplinary Cancer Care, John F.

Healthcare Reform’s Impact on Community Practice Oncology

The Patient Protection and Affordable Care Act has now passed both houses of Congress. Although it is thought that this will be an earth-shaking and complete overhaul of our healthcare system, in fact, the implementation won’t happen until 2014; and many of the details may get shot down as the plan moves forward.

Key among the reforms, over 1200 pages of verbiage, are the following, related to cancer care, which are of particular interest to our readers.

Oncology EHR: Taking the Road Less Traveled

In late 2009, researchers from the University College London reported that between 50% and 80% of electronic health record (EHR) systems are unsuccessful outside of a controlled testing environment. They observed that the bigger the EHR project, the more likely it was to fail. There have been colossal EHR failures in general medicine, with costs approaching billions of dollars. In the complex world of oncology, implementation has resulted in actual reversal of implemented systems in more than 10% of projects.1

ACCC Panel Says Get Ready for Comparative Effectiveness Research

Comparative effectiveness research (CER) is at the forefront of new cost-control efforts, according to a panel of experts. CER aims to evaluate both the clinical and cost-effectiveness of treatments through head-to-head trials, including preventive measures. And although CER promises important new clinical insights, no one doubts that rising health care costs are forcing payers and pro viders alike to think about driving value.

Diagnostic Imaging: Use and Reimbursement

Although major technologic advances continue, steep prices for equipment and heightened concern over radiation overdoses pose challenges for the field of diagnostic imaging, according to Jason Launders, MSc.

Launders, who is a senior project officer and medical physicist with the Health Devices Group, ECRI Institute, Plymouth Meeting, Pennsylvania, has focused his research on computed tomography (CT) scans.

Standardized Treatment Regimens: Improving Care, Lowering Cost, Clarifying Communication

Public and private payers are moving to control exploding healthcare costs, and increased cost control is inevitable, so it is in providers’ interest to get a seat at the table, according to Kimberly Bergstrom, PharmD, chief clinical officer for McKesson Specialty Care Solutions.

The Reimbursement Challenge for 2010

 NEW ORLEANS—As reimbursement for services continues to decline, oncology practices must be proactive and develop a strategy to minimize losses, said Steven L. D’Amato, RPh, BCOP, clinical pharmacy specialist with the Maine Center for Cancer Medicine, Scarborough, Maine. D’Amato was an invited speaker at the annual meeting of the Hematology/Oncology Pharmacy Association.

Pathways as a Model for Cancer Care Management

To date, healthcare reform efforts have focused mainly on insurance reform, not actual healthcare reform. This initial focus is understandable for many good and obvious reasons, but fails to address the larger issues of healthcare quality and its unaffordable cost trend. These questions are far more difficult and complex, and solutions must be found for the country to afford the expansion of access achieved in the new reform law.