WCOE: Discussions About the Costs of Care and How We Pay for Cancer Treatment

Discussions about the costs of cancer treatment and how we pay for cancer care dominated many of the cancer policy stories that caught our eye this week. In a Washington Post article from the Wonkblog, Jason Millman outlines some of the troubling statistics that project a significant increase in the costs of cancer care, as well as efforts by insurers and health-care providers seeking programs to rein in the skyrocketing costs. Millman reports the initial findings from a program launched by United Healthcare that pays oncologists for “episodes of care” rather than the margin on chemotherapy drugs and fees for services provided−a program anticipated to reduce the incentives of higher-cost treatments. In the program, physicians were paid more for lowering the overall cost of care or improving patient outcomes. Although the program produced savings, the spending on chemotherapy drugs unexpectedly increased.

Elaine Schattner’s most recent article in Forbes explores the critical issue of talking about the costs of care, and a new tool developed to measure patients’ concerns about the financial burdens associated with cancer treatment. The COmprehensive Score for financial Toxicity (COST) is a Patient-Reported Outcome Measure intended to help doctors better understand patients’ financial concerns. While noting the need for patients to have the chance to weigh the costs of care with personal goals, Dr. Schattner expresses concerns that the measurements will lead to a cycle of more measurements rather than carefully and thoughtfully evaluated medical treatments based on open conversations between patients and their health care team. Although we recognize the need to determine the most effective strategies for communication, we share her concerns, and have developed two new patient tools to help facilitate conversations between patients and their doctors.

NCCS has been closely monitoring payment reform for many years, and will continue to work towards fostering a patient-centered cancer care system that is affordable and accessible to all, and we have outlined this strategy through our principles for payment reform. As patient advocates, we believe that patients should care about how physicians are paid because the way we as a country, and Medicare as the largest payer, compensate physicians directly affects the care patients receive. As our current system is not sustainable for physicians, patients, or taxpayers, we welcome these critical discussions about how we pay for cancer care and the financial toxicities cancer patients face.