Gould is excited about the prospects for the bundled payment program that impacts the 21 medical oncologists at Northwest Georgia Oncology Centers because, he insists, the payments are wrapped around value.
Physicians can increase their episode payments by improving their results, through either improving patients' survival or decreasing the total cost of care, Gould says.
Physician involvement is essential to get the project going, says Leonard Kalman, MD, chairman of the board of managers for Advanced Medical Specialties of Miami, an oncology practice involved in an accountable care program with a Florida hospital and insurer.
"What's in it for the oncologist?" Kalman asks. "You have to buy the proposition that's where the payers want to move, including Medicare and Medicaid, so you better get on the bus, otherwise you will be left behind. That's the motivation."
"Risk does scare some people, but it also represents a potential opportunity. So we need to get comfortable managing a population," Kalman says. "If you can manage costs while maintaining quality, it's very possible that you will attract more patients."
Success key No. 3: Coordination
Prostate cancer care is expensive and highly variable in terms of quality and cost-efficiency, both in the hospital and at physician practices.
Urology practices provide most prostate cancer-related services, but they often lack data regarding quality of care in their practices. And even when the data is available, few physicians understand how to make changes to make improvements, according to the University of Michigan's Miller.
Recognizing these concerns, urologists from throughout the state of Michigan and Blue Cross Blue Shield of Michigan have partnered to create the Michigan Urological Surgery Improvement Collaborative.
The group includes a consortium of urology practices—representing about 60%-70% of all urologists in Michigan—to initiate coordinated care, says Miller. "In prostate cancer, there has been a fair amount of variation in care that has been well documented," he says. "It's a very expensive condition."
Miller says it's important that systems build guidelines to potentially reduce unnecessary testing of men with low risk of cancer. In a study, Miller said that in 2010 surgeons collected uniform data for men with newly diagnosed prostate cancer. Of 215 men having prostate cancer, 43% underwent testing, but only 9% of those were positive for the disease.
The MUSIC program has initiated guidelines to reduce unnecessary testing, Miller says. "We may be able to improve practice patterns and avoid many radiographic tests in low-risk patients," he says. At the same time, the work may "optimize the use of appropriate radiographic staging evaluations among men with a higher risk of cancers."