By Jennifer Hinkel, NCCN e-Bulletin Editor-in-Chief
The landscape for oncology reimbursement continues to present challenges for physicians and practices as both Medicare and private payors look at ways to more closely manage spending for cancer care. On October 30, the Centers for Medicare and Medicaid Services (CMS) issued its 2010 physician fee schedule, which included cuts to reimbursement for oncology services, including a one percent cut to reimbursement in 2010 as the beginning of an overall six percent reduction over four years.1 At the same time, private payors are increasingly looking to control oncology spending through pre-authorization and other mechanisms that may not only reduce reimbursement but also increase the administrative burden placed on oncology practices.2
Physicians, pharmacists, nurses, and other clinicians practicing in a variety of settings have communicated to NCCN that reimbursement issues are becoming ever more time-consuming and challenging. Some community oncologists have reported employing a full-time staff member in their practice dedicated solely to dealing with payor interactions, including obtaining pre-authorization and pre-certification when required for reimbursement. These anecdotal reports are supported by recent data indicating that nursing staff in specialty physician offices spend close to 20 hours per week interacting with health plans and managed care organizations, while clerical staff spend more than 30 hours per week interacting with health plans.3 Apart from the administrative burden caused by reimbursement processes, these requirements may slow patients' access to oncology care, as in some cases a practice is not able to start treating a patient until necessary approvals are received from a patient's managed care organization. Reimbursement also featured in discussions at recent NCCN Academy programs, as speakers and participants recognized challenges associated with reimbursement as ever-growing hurdles to providing care. From those discussions, reimbursement was identified as an area where multiple stakeholders should work together to improve the current processes.
As a response to these ongoing challenges, NCCN is introducing a new resource, the NCCN Reimbursement Resource Room, at the NCCN 15th Annual Conference to help oncologists address reimbursement challenges. The NCCN Reimbursement Resource Room will be a dedicated location where clinicians can visit and learn about reimbursement help and services available from industry. In the Reimbursement Resource Room, industry professionals who are knowledgeable about reimbursement programs and services and who interact with managed care will be available for individual discussions regarding various programs to help mitigate reimbursement challenges and better ensure that physicians are able to provide patients with access to appropriate oncology care.
For information on how to participate in the NCCN Reimbursement Resource Room, click here.
1. Nussbaum, Alex. “Medicare Eases Next Year's Cuts for Heart, Cancer Specialists.” Bloomberg.com. 2009 October 31. Accessed online at: http://www.bloomberg.com/apps/news?pid=20601103&sid=afBAqGPJb1HM
2. Managed Care and Medical Oncology: Cancer is Now on the Table. NCCN Oncology Insights Report 1, 2009 Available by request at: http://www.nccn.org/network/business_insights/oncology_trends/default.asp
3. Casalino LP et al. “What Does It Cost Physician Practices to Interact with Health Insurance Plans?” Health Affairs. 2009 May 14; Web exclusive: w534.