Table 5 Database search articles
From: Impact of oncologist payment method on health care outcomes, costs, quality: a rapid review
Authors | Title | Payment approach | Methods | Health issue | Outcomes measured | Findings |
|---|---|---|---|---|---|---|
Bailes JS and Coleman TS. 2014 (USA) | The long battle over payment for oncology services in the office setting [35] | Fee-for-service | Reviews Medicare policy history and reports expert opinion | Outpatient Chemotherapy | Physician fees for chemotherapy drugs | Payments for drug administration can be much less than its cost. Marginal revenue from drug payments is used to make up the difference, and drug payment decreases could result in provider losses. |
Bekelman JE, Epstein AJ and Emanuel EJ. 2014 (USA) | Getting the next version of payment policy “right” on the road toward accountable cancer care [11] | Fee-for-service vs. prospective payment | Reviews published literature and agency documentation | Cancer care | Changes in costs and outcomes | Prospective payment systems should include performance measurement to counter associated perverse incentives. For complex cases lump sum payment could be combined with fee-for-service. |
Elit, L. 2006 (Canada) | An analysis of alternative funding for physicians practicing gynecologic oncology in Ontario, Canada prior to 2001 [36] | Fee-for-service | Literature search, discussion with stakeholders, meeting minutes from groups considering alternate funding systems | Gynecologic cancer | Events preceding reform of the funding agreement with gynecologic oncologists | Fee-for-service does not account for the increased complexity of services on cancer patients, causing losses and making recruitment and retention difficult. |
Elit L, Cosby J and Gynecologic Oncology Group in Ontario. 2006 (Canada) | Does shifting a physician payment system shift physician priorities? A multi-site evaluation of an alternative payment plan (APP) for gynecologic oncologists in Ontario [37] | Fee-for-service vs. a negotiated arrangement where contracts are made with physician groups who are paid a fixed amount regardless of productivity | Interviews with 14 Ontario gynecologic oncologists; interviews were analyzed using grounded theory. | Gynecologic cancer | Changes in physician behavior in response to the new payment system | The new plan improved quality of life and income predictability, increased preventive health care work. Vacancies were filled and staff were retained. Staff delegated follow-up with less complicated patients. The plan did not reduce workload. |
Greenapple R. 2013 (USA) | Rapid expansion of new oncology care delivery payment models: results from a payer survey [40] | Comparing “clinical pathways” (bundled payments with quality management), capitation, shared savings and pay-for-performance | A validated survey of payers representing more than 100 million individuals that asked payers about models of care that could improve quality and reduce costs. | Cancer care | Payer perceptions of which payment models are most effective | Payers believe that clinical pathways can reduce clinical variation in care, improve quality and reduce costs, mainly by reducing end-of-life costs |
Habermann EB, Virnig BA, Riley GF, and Baxter NN. 2007 (USA) | The Impact of a Change in Medicare Reimbursement Policy and HEDIS Measures on Stage at Diagnosis Among Medicare HMO and Fee-For-Service Female Breast Cancer Patients [31] | Fee-for-service vs. health maintenance organization (capitation) | Compares the effect of change from biennial to annual mammograms by payment method. | Breast cancer | Surveillance Epidemiology and End Results, Medicare claims database | Women enrolled in the health maintenance organization were more likely than those in fee-for-service to be diagnosed early both before and after the, but after the change, the disparity shrank from 4.7 to 2.3 %. |
Kuo RN, Chung KP and Lai MS. 2011 (China) | Effect of the pay-for-performance program for breast cancer care in Taiwan [40] | Fee-for-service/activity-based funding vs. pay-for-performance (encouraging evidence-based therapy and reward better patient outcomes) | A retrospective analysis of patients who received curative surgery. Multivariate regression analyzed the association between program enrollment and quality of care. | Breast cancer | Population-based cancer registration and claims data | Enrollees received higher-quality care, had better 5-year overall survival and less recurrence |
Makari-Judson G, Wrenn T, Mertens WC, Josephson G and Stewart JA. 2014 (USA) | Using Quality Oncology Practice Initiative Metrics for Physician Incentive Compensation | Pay for performance | Based on their performance in five achievement categories, physicians were offered a bonus percentage of salary corresponding to the target level achieved. | Hematology oncology | Work relative value units, Quality Oncology Practice Initiative metrics, patient emotional well-being from medical records, academic goals and the overall financial success of the group | Results are reported for two measures: quality and emotional well-being. For the former, “Tier III” was achieved resulting in a bonus of 24 % salary. For the latter no bonus was achieved. |
Newcomer LN, Gould B, Page RD, Donelan SA and Perkins M. 2014 (USA) | Changing Physician Incentives for Affordable, Quality Cancer Care: Results of an Episode Payment Model | Fee-for-service vs. episode payments (bundled payments) | Physicians at five medical oncology groups were reimbursed with a single episode payment for services to cancer patients as part of a pilot program. The episode cohort was compared with a control fee-for-service cohort. | Breast, colon and lung cancer | Clinical data corresponding to characteristics of episode payments (cancer type, stage, genetic profile), claims data, average chemotherapy drug sale price | The total medical cost for the episode cohort was $33.4 million less than what was predicted using fee-for-service. |
Patel KK, Morin AJ, Nadel JL and McClellan MB. 2013 (USA) | Meaningful Physician Payment Reform in Oncology | Clinical pathways (bundled payments), pay for performance, fee-for-service | Reviews pilot initiatives in the US that combine physician payment reforms with delivery reforms. | Cancer care | Research on oncology practice and the impact of physician payment methods, proposals from oncology societies | The authors propose a payment model that combines fee-for service payment with case management payment and a care coordination fee, increasing total provider payment but potentially decreasing the total care cost. |