A Slow Evolution
MD Anderson is a natural choice to launch a pilot program on bundled payments, because it is “an integrated practice,” Dr. Feeley said. “Our medical practice is integrated with our hospital and with our clinic,” he said. “When we receive payments from United, we don’t have to parse out payments within our system.”
Explore this issue:September 2015
The bureaucratic hurdles of attributing cash flow and revenue would be obstacles to implementing a similar pilot program at other institutions, he said. And while, of course, there are other large “integrated medical centers that could launch their own initiatives,” Dr. Feeley doesn’t expect a raft of them anytime soon. “This is going to be a very, very slow evolution,” he said.
Launching MD Anderson’s pilot with head and neck cancer patients also makes logistical sense, Dr. Weber said. First, the number of patients is much smaller and more manageable than a program tailored to, say, breast or lung cancer. Second, the hospital has long operated using a multidisciplinary approach that makes communication easier for a program like this.
“For 30 years here, we’ve had a very integrated multidisciplinary team, so we all work very closely together,” he said. “We communicate very frequently about patients. We meet once a week at our tumor conferences. So bringing us together to engage in this project was perhaps easier.” Physician buy-in at MD Anderson was also pretty easy, Dr. Feeley said.
It’s also important to make sure that patients know that payment initiatives have zero impact on the quality and timeliness of the care delivered. To that end, physicians don’t know which patients are enrolled in the program and which ones aren’t. That allows doctors “to remain agnostic about that so that we just treat the patients the way we would normally treat them,” Dr. Weber said.
Dr. Feeley wants patients who have heard about the pilot program to understand it’s not about rationing care or trying to find cheaper alternatives. In fact, he is hopeful some of those patients might take comfort in knowing their care is being paid for in one lump sum. “Cancer patients in general get a ton of bills when they enter treatment,” he said. “I’m really hoping that, for the patient, this is one less source of anxiety while you’re being treated for head and neck cancer.”