ASCO Demands Revamp of Site Neutrality Policy in Oncology

In a paper published in the Journal of Clinical Oncology, the American Society of Clinical Oncology (ASCO) has made recommendations to Medicare reimbursement that will provide a fair balance between best practices for the patient and also address disparities.

Policy experts at ASCO are of the opinion that the current site neutrality discussion is based on a flawed argument that compares outpatient cancer treatment settings. They believe that the Medicare Physician Fee Schedule (MPFS) and the Hospital Outpatient Prospective Payment System (HOPPS)–2 systems developed to establish Medicare reimbursement for outpatient services–cannot be swapped, explaining that the 2 systems were developed using completely different data sets. Each system, the paper explains, was based on the aggregate amount of annual Medicare funding allocated to each setting of care. Being independent in the economic sense should prevent 1 reimbursement system from influencing the other, the paper concludes. 

The specific recommendations include:

1. Creating value-based incentives that raise quality and lower cost rather than arbitrarily cutting payment levels based on the site of care.

2. Ensuring that payment levels for physician practices provide adequate support for the full scope of medical and ancillary services required to treat individuals with cancer.

3. Engaging in additional study of the full scope of services required by patients with cancer, including the specific needs of low-income individuals, before implementing any change in resources paid to oncology practices and hospitals.

4. Transforming Medicare coding and payment for outpatient cancer care by implementing policies that are consistent with proposals such as ASCO's Patient-Centered Oncology Payment model.

“Private payer initiatives have demonstrated that even greater cost savings can be achieved by transforming and improving the oncology care delivery model compared with traditional site-neutrality initiatives,” said Philip J. Stella, MD, chair of the ASCO Government Relations Committee, in a press release. “Conversely, cutting reimbursement levels based on site-neutrality could limit the scope of services available to Medicare beneficiaries across treatment settings.”

Opinions, of course, vary depending on who participates in the conversation. Community oncologists would swear by the need for payment reform that would eliminate site barriers, as Barry Brooks, MD, chair of the P&T Committee for The US Oncology Network, wrote in the August issue of Evidence-Based Oncology.