Medicare was supposed to start paying more for quality instead of quantity when it came to patient care, but apparently it doesn’t have the tools to do that with cancer, according to a new analysis.
Research firm Avalere Health said Monday that Medicare has hardly any quality measures for cancer, which are used to drive reimbursement decisions and measure value.
Medicare uses more than 20 programs to measure the quality of care for clinicians, hospitals, health plans and other types of care centers. Quality measures for cancer include when chemotherapy should be administered to a patient and how much, whether there were adverse events and if the patient took his or her medication.
The measures can be used to determine how much doctors and hospitals get for treating patients.
However, Avalere found that such measures are lacking for cancer, even though the government has made lower cancer costs a priority. Cancer cost the United States an estimated $263.8 billion in medical costs and productivity in 2010, according to the National Institutes of Health.
For instance, conditions such as chronic kidney disease and diabetes have 21 measures each, while prostate cancer and lung cancer each have three measures. Those two types of cancers are the most prolific in the United States.
Medicare doesn’t have any quality measures for endometrial cancer, which begins in the uterus. This year nearly 55,000 cases will be diagnosed and about 10,000 women will die, according to statistics from the American Cancer Society.
In 2010, a federal committee was created to look at any gaps in the quality measures that govern Medicare reimbursement. However, Avalere suggested that the development and adoption of those measures are still uneven in leading conditions.
The data is concerning because quality measures are becoming a driving force in healthcare, said Avalere CEO Dan Mendelson.
“As Medicare and other payers move towards value-based payments for services and pharmaceuticals, we need more meaningful quality measures in oncology,” he said.
The assessment comes a few months after the Centers for Medicare and Medicaid Services introduced a new model for paying for cancer care.
Under the new model, a doctor’s office or physician group will get paid based on how a patient’s cancer is treated over a six-month period that begins with the first chemotherapy drug being issued.
