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AJMC®TV interviews let you catch up on what’s new and important about changes in healthcare, with insights from key decision makers—from the clinician, to the health plan leader, to the regulator.
Stephen Schleicher, MD, MBA, Medical Oncologist, Tennessee Oncology
What are your thoughts on the proposed Radiation Oncology Model and the fact that CMS wants it to be mandatory?
The big hype right now is this proposed radiation oncology bundled payment. This would be the first true bundled payment to come in oncology. The [Oncology Care Model] OCM is an episode-based payment, but it is not a bundle, and then the other experiments like Medicare’s [Bundled Payments for Care Improvement], the comprehensive joint replacement model—both had nothing to do with oncology. So far in oncology, outside of [Merit-based Incentive Payment System], the OCM was voluntary, so this is a big change in oncology to have a mandatory payment model, and as we’ve seen in OCM, there are unpredictable consequences of the methodology, such as the novel therapy drugs coming out after the baseline.
So, in my opinion, I’d prefer a voluntary model where groups that are excited about being on the cutting edge can be a part of that and help us learn where the challenges are in bringing a bundle to radiation oncology and then perhaps make it mandatory in the future, based off the initial feedback.
How does the implementation of high-cost, novel drugs into clinical practice after the baseline period cost calculations further add to the challenge of lowering costs under OCM?
This remains a challenge since the baseline period was up until 2015 and we had this, really, immunotherapy boom happen after that. So, it is a challenge and Medicare does a great job trying to predict what costs should be based off these new novel therapies, but we have some data that was presented at [the 2019 American Society of Clinical Oncology annual meeting] ASCO and is going to be published shortly showing that this is still not a perfect methodology to account for these, so I think understanding those challenges and trying to understand the risk that those challenges have on us going forward is important. I will say performance period 4, which included the first half of 2018, was when immunotherapy came to the front line of non-small cell lung cancer, so it was kind of a test case for the model, and I think I was pleasantly surprised that the prediction had been better than expected when we got our performance period 4 results.