Insurer tries new way of paying doctors to treat cancer

[babylonsister]

Insurer tries new way of paying doctors to treat cancer

By Julie Appleby, Kaiser Health News | Kaiser Health News


WASHINGTON — One of the nation's largest health insurers said Wednesday that it was testing a new way to pay for some cancer treatments, aiming to identify the best medicines and to limit doctors' profits from dispensing in-office chemotherapy drugs.

The action by UnitedHealthcare comes as insurers, employers and the government look to streamline costs by paying doctors and hospitals lump sums for an entire course of care, rather than fees for each service provided.

Payment for chemotherapy has been particularly controversial, because some doctors, including oncologists, buy drugs at wholesale prices, dispense them by injection or infusion to patients in their offices, then charge insurers higher, retail prices.

A government report found that Medicare, for example, reimbursed doctors at least $532 million more in 2000 than the doctors had paid to purchase the medicines. In 2005, Medicare changed the way it pays for in-office drugs, ratcheting down payments to average sales prices plus 6 percent. A few private insurers followed suit.

UnitedHealthcare takes a different approach. Its program, under way with five oncology practices in five states, pays physicians lump sums for each patient's course of chemotherapy for breast, lung or colon cancer. The payment is based on regimens the doctors draw up themselves, plus case management fees.

It's the first large foray into payment "bundling" for chemotherapy by a private insurer, although other insurers are testing the approach for hip and knee replacements, and Medicare will launch a program next year that combines drugs with dialysis services. The new health overhaul law also calls for such payments.

more...

http://www.mcclatchydc.com/2010/10/20/102350/insurer-tries-new-way-of-paying.html


Read more: http://www.mcclatchydc.com/2010/10/20/102350/insurer-tries-new-way-of-paying.html#ixzz12wfRLvDI

[KT2000]

1. Cancer is big business and

I can see how this is going to turn out. Difficult cases will not be accepted, difficult patients will not have very good outcomes etc.

[stray cat]

2. Right now the people treating you that you pay tell you what you need to buy

no checks or balances

[BrklynLiberal]

3. Heard about this on the radio this AM.

Sad that Cancer treatment is such big busine$$ for all concerned....except for the patient.

[stray cat]

5. and this may be a step to changing that if we are lucky

the profit needs to be taken out of medicine

[EvolveOrConvolve]

7. Unfortunately, this isn't a step towards taking the profit out of medicine

It's just shifting the profit from the practitioners to the insurance companies. I can guarantee that the insurance companies aren't going to pass that savings along to the consumer. When was the last time you saw your insurance rates go down?

[FiveGoodMen]

4. Sure glad we didn't even argue for single payer

In fact, a Democrat had the people who wanted to argue for it arrested, as I recall.

This is what we get because we think politics is just a game.

[stray cat]

6. Medicare is also having problems with doctors and cancer treatment