Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

News

New Pilot Program Bundles Cancer Care Payment

By Ryan Mcaskill

MD Anderson and UnitedHealthcare have launched a new pilot program for bundled cancer care payments.

- There is no question that paying ongoing care can be a challenge for some patients, even with insurance. Patients dealing with cancer, for example, have expensive tests, long-term treatments, follow-up care and supportive services that need to be paid for.

This type of challenge has some healthcare payers and providers looking for new ways to handle payments. It was announced last month that the University of Texas MD Anderson Cancer Center and UnitedHealthcare have partnered to launch as pilot program that explores a new cancer care payment model for head and neck cancers that focuses on quality patient care and outcomes. This is the first time that a bundled payment method that reimburses a care provider for a defined episode of care under a single fee or payment had been tried at a large, comprehensive cancer center.

In an interview with RevCycleIntelligence.com, Thomas Feeley, M.D., head of Anesthesiology and Critical Care, and head of the institute, spoke about how the pilot program came to be and why it is important.

According to Feeley, MD Anderson Cancer Center’s Institute for Cancer Care Innovation and UnitedHealthcare discussed the possibility of doing a pilot for a new payment model for some time. Both groups share a common goal of providing quality care while managing costs and the pilot was officially launched in November 2014 at MD Anderson.

  • Expensive Hepatitis C Drugs Quadrupled Prescription Spending
  • How Can Practices Improve Claims Management, Reimbursement?
  • Hospital Claims $173,000 in Medicare Overpayments
  • Healthcare Leaders Express Confidence for 2015
  • How the 21st Century Cures Act Impacts Medicare Reimbursement
  • 721 Hospitals Penalized for Hospital-Acquired Condition Rate
  • Judge Calls for Medicare Appeals Backlog Elimination by 2020
  • 90% Report Clinical Documentation Improvement Boosted Revenue
  • 91% of Eligible Clinicians Participated in 2017 MIPS Reporting
  • How the Affordable Care Act Impacted Healthcare Revenue Cycle
  • AHA: Global Budget Payments Help to Treat Vulnerable Communities
  • CMS Rule Addresses Medicare Fraud, Overpayment Compliance
  • HHS Sec. Burwell Shares Vision for Value-Based Care Future
  • Value-Based Purchasing, Consumerism Top Healthcare Exec Challenges
  • How Revenue Cycle Management Became an Important Career
  • New Docs Don’t Use Social Media for Healthcare Recruiting, Jobs
  • Unreliable Health Plan Provider Directories Burden Providers
  • Sutter Health Destroys Evidence for Case on High Healthcare Prices
  • CMS Details How to Resolve ICD-10 Implementation Issues
  • Value-Based Care Implementation Delayed for Most Hospitals
  • Prescription Drug Spending Higher at 340B Hospitals, Study Finds
  • Commitment Key to Successful Value-Based Reimbursement Adoption
  • CMS Answers ICD-10 FAQs for Healthcare Providers
  • CMS Issues Proposed 2017-2018 Basic Health Program Notice
  • Why Revenue Cycle Management Needs Greater Patient Advocacy
  • AMA, AHIP, and Others Oppose Upside-Only ACO Changes for MSSP
  • Hospital M&A Driving Variation in Healthcare Costs by Site
  • OIG: NJ Agency Falsely Claimed $95M in Medicaid Reimbursement
  • HHS Proposes Changes to Medicare Reimbursement Appeals Process
  • New York State Agency Made $79K in Inappropriate Medicaid Claims
  • Maximize Hospital Revenue with a Holistic Insurance Discovery Strategy
  • May 8: Week That Was in Healthcare Fraud and Malpractice
  • CMS Clarifies Healthcare Price Transparency Rules for Hospitals
  • Healthcare Payment Integrity is Vital to Maximizing Reimbursements
  • Patient Billing Challenges Revenue Cycle Management
  • 4 State Medicaid Agencies Secure ICD-10 Deadline Extension
  • CMS Extends Application Period for Next Generation ACO Model
  • Medical Specialist Demand Rises as Primary Care Searches Dip
  • CMS Proposes Revisions to Medicaid Improper Payment Programs
  • Few Docs Familiar with MACRA, Transitioning to Value-Based Care
  • With ICD-10 Tomorrow, Are Revenue-Neutral Results Unlikely?
  • How to Plan Out the Transition to Value-Based Reimbursements
  • KLAS: Quadax, SSI Group Earn Top Scores for Claims Management
  • 10 Orgs Call for Medicare Advantage APMs to Qualify for MACRA
  • Healthcare Mergers, Consolidation Increase Patient Safety Risks
  • GOP Doctors Caucus Suggests MACRA Implementation Changes
  • FQHCs Push for Health Center Medicaid Payment Reform Models
  • CMS OKs Medicaid Reimbursement for Substance Use Treatment in NH
  • WEDI: ICD-10 Coding Guideline Negates Some Claim Audit Policies
  • February 13: The Week That Was in Healthcare Fraud and Legality
  • Examining Revenue Cycle Management Ethics Questions
  • Fixing Medicare, Medicaid a Top Priority for New Coalition
  • ACO Financial Risk Rules for Pathways to Success Raise Concerns
  • Epic Systems Tops List of Hospital RCM Technology Users
  • OK Physician Pays $580K to Settle Medicare Fraud Allegations
  • Black Book: CFOs Focused on ROI, Revenue Cycle Outsourcing
  • Affordable Care Act Saved Medicare Beneficiaries $20 Billion
  • CMS Details Rationale Behind Hospital Quality Ratings
  • VUMC Sees Operating Income Decrease After EHR Implementation
  • HHS, DoJ Recovered $3.3B From Healthcare Fraud Cases in 2016
  • Physician Compensation at Non-Academic Hospitals Up to $123K More
  • 46% of Providers Unsure About Value-Based Purchasing Impact
  • New Study Examines Payment Model Best Practices
  • Healthcare Sustainability Faces Challenges Worldwide
  • Hospitals Write Off 90% More Claim Denials, Costing up to $3.5M
  • Industry Groups Call on CMS to Modify MACRA Patient Codes
  • How to Bend Healthcare’s Cost Curve Over the Next Decade
  • MedPAC Suggests Cutting Medicare Reimbursement for Stand-Alone EDs
  • UNC Health Care, Atrium Health Scrap Hospital Merger Deal
  • Patient Scheduling Still Problematic at VA Medical Settings
  • Value-Based Care Penalties Spark Greater Quality Improvements
  • Asthma Education Model Lowers Resource Use, Healthcare Costs
  • AHA, AAMC Sue HHS Over Site-Neutral Payment Expansion
  • Top HIMSS15 Revenue Cycle Educational Sessions
  • Exploring Quality Measures Under Value-Based Purchasing Models
  • Hospital Markups Drive Prescription Drug Spending, PhRMA Says
  • ACO payment reform proposed in new legislation
  • 36% of ACOs Consider Quitting MSSP Under New Proposed Rules
  • 61% of ACO Contracts Only Include Upside Financial Risk
  • Physician Shortage Drives Boost in Nursing, Physician Assistant Pay
  • December 11: Week That Was in Healthcare Fraud and Malpractice
  • June 12: Week That Was in Healthcare Fraud and Malpractice
  • 74% of Providers See Increased Patient Financial Responsibility
  • Top 10 ICU Diagnoses Driving Up Healthcare Costs, Care Variations
  • Value-Based Reimbursement May Not Bring Benefits for SNF Care
  • New Rules for Bundled Payment Models for Cardiac, Hip Care
  • How St. Luke’s CFO Succeeds at Revenue Cycle Management
  • AHA Reacts to Proposed Anti-Kickback Statute Revisions
  • Quantify Denial Rates for Smooth Revenue Cycle Management
  • Opioid Overdose Care Totals $1.94B in Annual Hospital Costs
  • Less Than a Third of Docs Owned Independent Practices in 2018
  • Value-Based Care Spurs Higher Physician Consolidation Rates
  • High-Risk Patient Management Did Not Drive Early ACO Cost Savings
  • Black, ACR Praise CMS’s ICD-10 12-Month Safe Harbor Period
  • Patient Financial Responsibility Not Owed Top Medical Debt Issue
  • Executive Order Calls for ACA Financial, Marketplace Flexibility
  • CMS Paid $4M in Excess GME Medicare Reimbursement, OIG Finds
  • ACA Adds Billions in Bureaucratic Waste, Administrative Costs
  • High-Cost Patients Widely Distributed Across Hospitals, Markets
  • Is Consumer-Centric Revenue Cycle Management the Solution?
  • This is something that MD Anderson and its care center have been examining for the last five years. The new pilot will last three years and deal only with about 150 patients newly diagnosed with cancers of the salivary glands, oral cavity, throat and larynx, and who are enrolled in certain employer-sponsored benefit plans insured or administered by UnitedHealthcare.

    “This pilot reflects the first major look at a change in reimbursement for cancer care in many years,” Feeley said. He added that differs from the current fee-for-service model because: “under the pilot program, MD Anderson will not  be paid for every visit and procedure but for all the care over a fixed period of time.”

    According to Feeley, cancer offers unique challenges for patients because of the sheer number of obstacles that need to be overcome. Not only are their doctor’s visits to pay for, but every procedure, test and treatment – including chemotherapy, surgery or radiation therapy or a combination of the three – that follows. This process can happen over a span of many month. On top of that, there are follow-up visits with any number of providers and specialists. Now, instead of multiple “confusing statements,” patients in the program will receive one comprehensive bill.

    “[MD Anderson] have been looking at how to best approach a single price for treating cancers.  It is a complex question because cancer is a complex disease and each patient unique,” said Feeley. “Bundled pricing is something that patients and care providers want, and this is our first opportunity to better understand how we can manage costs without sacrificing quality care and patient outcomes.”

    Feeley added that while this pilot is starting with cancer centers, if successful it could be applied other practice settings. Ultimately, it is believed that this is a better way to pay for value.

    “Our partnership with MD Anderson Cancer Center marks an important step toward expanded bundled care payment models and away from the traditional fee-for-service payments for oncology care,” Lee Newcomer, M.D., United Healthcare’s vice president, oncology, said in the press release about the . “Our recently completed pilot shows that these creative new cancer care payment models can reduce healthcare costs while improving patient outcomes. MD Anderson’s work with value-based workflows makes them a natural partner for bundled payments.”

    Patients who are a part of the pilot program will get the exact same care if they were not a part of the program paying for fee-for-service. Feeley said that clinicians will not know who is or isn’t in the bundle pilot. Instead, both groups will be examined to determine the economic impact of the pilot.

    Ultimately, this is new territory for both sides as the pilot will test the feasibility of bundling. With an increased focus on value-based care, pilot programs like this will become more common.

    X

    Join 30,000 of your peers and get free access to all webcasts and exclusive content

    Sign up for our free newsletter:

    Our privacy policy


    no, thanks

    Continue to site...