Are Oncology Clinical Pathways Coming to Medicare?

“We may be able to work on a framework in the first quarter, and start organizing the pilot perhaps six months later.”
Matt Brow, Vice President, Business Development and Public Policy, McKesson

PLAINSBORO, N.J. – Oncology clinical pathways could get a tryout through Medicare, the nation’s largest provider of cancer care, sometime this year if federal officials accept a proposal from McKesson and the National Comprehensive Cancer Network.

Matthew Brow, Vice President for Business Development and Public Policy at McKesson, told Evidence-Based Oncology in the current issue that the Centers for Medicare and Medicaid Services (CMS) is reviewing a proposal from McKesson and NCCN to utilize their oncology clinical pathways. Brow told EBO, a news publication of The American Journal of Managed Care, that if the proposal is accepted, McKesson believes that CMS will roll it out as a pilot project in certain oncology practices and hospital settings sometime in 2014.

“We may be able to work on a framework in the first quarter, and start organizing the pilot perhaps six months later,” Brow told EBO. If the pilot is successful after 2 or 3 years, “We hope Medicare will look to roll it out more broadly.” For a copy of the story, click here.

Clinical care pathways have made headway in oncology care as a way to ensure quality and manage costs. Variation among practices has prompted payers to promote the use of pathways to standardize treatment options. But thus far, there is little standardization among pathways, which can create administrative challenges for a busy oncology practice. Thus far, however, the biggest payer of all, CMS, has not moved in this direction. Some believe that if CMS adopted a pathways model it would set the standard for all such programs.

The stakes for taxpayers if CMS adopted a pathways model are significant. In 2011, Medicare spent $34.4 billion for cancer care, which represents 10% of its total fee-for-service payments for the year. Today, most patients diagnosed with cancer received Medicare, and the share is only expected to grow.

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