In the April issue of Value-Based Cancer Care (that’s a journal), there’s an article talking about a keynote presentation and a study highlighting a big problem for patients with cancer: toxicity. It’s a fact that some chemo agents are pretty toxic, but in this health care podcast I am talking about financial toxicity. The financial burden of cancer care has a seriously negative influence on patients’ quality of life.
This keynote speaker quoted in the Value-Based Cancer Care article implored his fellow oncologists: “Think twice before ordering costly interventions that may have little impact on the clinical course,” he said.
This might be difficult for a number of reasons, and one of them is that oncology centers make money, a whole lot of money, sometimes the most money, from infusing cancer medications. It’s this little payment paradigm called “buy and bill.” The cancer center buys the meds and then gets paid an additional fee to infuse the drug. This fee is a percentage of the drug cost. It ranges from 4.5% to about 20% of the cost of the drug.
You’ve probably heard a lot lately about the skyrocketing costs of some of these cancer agents. Add 4.5% to 20% onto those costs and realize that if you’re an oncology center, the higher the drug costs, the higher your revenue. Now consider the patient suffering under the weight of increased cost sharing and employers and taxpayers who are funding this strange payment model.
In this health care podcast, I dig into this so-called “buy and bill” payment model with Aaron Mitchell, MD, MPH. Dr. Mitchell is an oncologist and health services researcher over at Memorial Sloan Kettering. He seeks to understand how changes to current reimbursement models for oncology services may be used to achieve better patient outcomes and reduce low-value care.
You can learn more at drugpricinglab.org. You can also connect with Dr. Mitchell on Twitter at @TheWonkologist.
Aaron Mitchell, MD, MPH, is a practicing medical oncologist and health services researcher. He is an assistant attending at Memorial Sloan Kettering Cancer Center in the department of epidemiology and biostatistics. His research focuses on understanding how the financial incentives in the health care system affect physician practice patterns and care delivery to cancer patients. He cares for patients with prostate and bladder cancer.
03:00 Following the drug and following the dollar.
03:28 The “buy and bill” system.
04:15 The perverse and problematic incentives of the system.
07:24 “It creates the incentive for us to gravitate toward the more expensive drug.”
07:28 The hesitancy to address the financial toxicity of drugs for patients.
08:40 Why the only person losing in this situation is the patient.
09:40 The financial impact from the patient perspective.
13:07 Are patients realizing this impact?
13:53 Solving the problem of oncology drug choice.
16:06 Reimbursement reform.
17:49 Capitated systems and incrementalist impacts to reimbursement reform, and what these look like.
23:04 Are we at a tipping point?
23:27 “The current system … works too well for too many people.”
24:47 Who isn’t well served by the current system.
26:27 Who has to lead the charge for change.
29:54 Large oncology providers vs small oncology providers in the buy and bill system.