Hollywood, FL—As new models of oncology care evolve, they should not dismiss the importance of multidiscipline involvement, Thomas A. Marsland, MD, President, Integrated Community Oncology Network, Orange Park, FL, maintained in his talk at the 3rd Annual Conference of the Association for Value-Based Cancer Care. Dr Marsland is also Past President of the Florida chapter of the American Society of Clinical Oncology.
Many specialists are involved in the diagnosis, treatment, and follow-up care for cancer. Dr Marsland envisions a multidisciplinary practice that brings together, within a cancer center model, disparate groups using ancillary-type revenue from radiation, imaging, laboratory services, and so forth to provide incremental revenue to practitioners that may entice them to stay independent.
Multidisciplinary specialties could be a viable model for cancer care in the future, Dr Marsland said. The trend in alternative payment models, such as accountable care organizations and medical homes, is to foster a multidisciplinary team approach—to get rid of fragmentation and duplication for better coordination of care. This requires the true integration of clinical care, he emphasized.
“The key thing is, it will not be ‘one size fits all,’” Dr Marsland added. “Markets are going to be different, and you will have to be a dominant player in your market. You don’t have to be the dominant player, but you have to be big enough that you can’t necessarily be excluded or frozen out of a system that’s looking to provide cancer care.”
Value Has Always Been There, in the Community Care Model Dr Marsland takes exception to the idea that there has not been value in oncology. “I think the oncology care in the United States is the best in the world. Deaths rates have declined 20% in the last 20 years. I think part of this is due to this whole world of practice that I grew up in—the buy-and-bill, fee-for-service, community-based, infusion-model therapy. Access to quality care in the community has had an impact on survival,” he insisted.
The ability to provide most cancer care in a community setting has been a big part of the value proposition, Dr Marsland suggested. “But now we are being asked to provide better-quality care and attain higher survival rates, at a reduced cost. What they are asking for is a relative value increment,” he said.
Rising healthcare costs cannot continue indefinitely. Costs are rising because more patients are living longer using costly therapies delivered amid systemic inefficiencies, Dr Marsland suggested.
The new models stress patient-centric quality outcomes that will be measured and rewarded. Across the models there are some consistent elements. One important component is that patients and physicians are integral to the development and testing of the models. Unfortunately, this was not done for the Medicare Modernization Act of 2003, when average sales price + 6% was instituted, Dr Marsland noted.
Who Will Chart the Value Course? “The question again is, who gets to decide? Who will be charting the future?” Dr Marsland continued. “I think it’s partly the role of organized medicine to drive these changes and be involved in defining what value and quality really are.”
The main driver will be data, he said, “but what data, and data collected by whom?” Although physicians, payers, and industry are all collecting data, it is important that these data are shared, Dr Marsland emphasized.
“I think that’s been part of the problem in the past, with some of the payers not always sharing cost data. They were asking us to help to control costs, but we didn’t really always know what those costs were,” he pointed out.
That enlarging database now includes genomics and proteonomics. This will increasingly impact drug development, clinical trial design, and drug usage, including treatment off label.
Finally, one of the biggest tasks will be to establish the best means of compensating for the attainment of “value,” Dr Marsland concluded. “We live in a relative value unit (RVU) world, based on CPT [Current Procedural Terminology] and ICD-9 [International Classification of Diseases, Ninth Revision] codes. Compensation is often based on RVUs, yet for many of these new things, there are no RVUs assigned. How will we address these issues? These are challenges that we face going forward in all of this.”
