What Happened When Doctors Were Paid to Spend More Time With Cancer Patients? Not Much, AJMC Study Finds

The movement toward "value-based" care assumes that if financial incentives are realigned away from rewarding those who prescribe expensive drugs, behavior will shift. A study from The American Journal of Managed Care suggests that change might not happen overnight.

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A study in The American Journal of Managed Care is at odds with assumptions that have been made about what will happen when oncologists' financial incentives are realigned.

We found that, surprisingly, moving financial incentives from drug administration toward cognitive services did not alter physician behavior with regard to type or frequency of chemotherapy administrations.

(PRWEB) April 27, 2014

A study published this week in The American Journal of Managed Care found that revamping payments to cancer doctors—to reward them for spending more time with patients and less for prescribing drugs—did little to change their behavior. Authors of the study, “Physician Behavior Impact When Revenue Shifted From Drugs to Services,” say this should be a warning to policy makers that changing reimbursement models, while worthwhile, may not yield savings overnight.

Current thinking in healthcare reform, including statements from oncologists themselves, seeks to shift reimbursement in cancer care away from payment as a percentage of drug costs. Critics attribute soaring cancer care costs to ever-increasing prices for breakthrough drugs, alongside current reimbursement models.

Authors of the new study, led by Bruce A. Feinberg, DO, vice president and chief medical officer, oncology, at Cardinal Health Specialty Solutions, examined whether physician behavior changed under a different reimbursement system; one that rewarded doctors for using less-expensive drugs and paid them more for cognitive services, such as survivorship planning.

Dr Feinberg’s team conducted a retrospective study of oncologists practicing within a new delivery model called a Patient-Centered Medical Home (PCMH), which is designed to better coordinate patient care. Oncologists practicing in the PCMH were paid under the revised reimbursement model. Researchers compared this group’s behavior with that of other oncologists who were part of a broader study that examined whether clinical care pathways save money. (A year ago, the authors published results that showed pathways reduced cancer costs by 15% and trimmed hospital stays by 7%.)

The new study compared 2 years of claims data; researchers looked at claims from April 1, 2010, to March 31, 2011, just before PCMH implementation, and data from April 1, 2011, to March 31, 2012, after implementation.

To their surprise, the authors found that the PCMH oncologists’ behavior was indistinguishable from behaviors exhibited in the control group. The 2 groups had virtually the same percentages of patients on chemotherapy, and they shifted patients to generic drugs at the same pace over time. Notably, the PCMH oncologists did not increase the amount of patient contact, even though they had an economic incentive to do so.

“We found that, surprisingly, moving financial incentives from drug administration toward cognitive services did not alter physician behavior with regard to type or frequency of chemotherapy administrations,” the authors write. “We say surprisingly, as expectations based on prevailing wisdom suggest physicians behave in their economic best interest as long as patient outcomes are not jeopardized.”

The authors acknowledge that they can only speculate on reasons for these results. One cause, the authors state, may be the fact that the doctors involved were already in a pathways program with “established patterns of care that limited variance.” In other words, this particular group of oncologists may have been less likely to alter practice patterns for purely economic reasons.

Previously, Dr Feinberg has discussed the difficulty of changing physician behavior, or what he calls “the culture of medicine.” At the November 2013 conference, Patient-Centered Oncology Care, sponsored by The American Journal of Managed Care, Dr Feinberg said that medicine, and cancer care in particular, had to address a philosophy of “now over later, new over old, and more over less.”

It is unclear whether the “culture of medicine” accounts for the results in the AJMC study, but the authors mention it as an item for further study. “Whether this pattern of care was pathway-influenced or is the result of National Comprehensive Cancer Network and other guidelines, brand name prescription drug detailing, cognitive dissonance, our culture of medicine, or other factors, is speculative without more information,” they write.

About the Journal

The American Journal of Managed Care, now in its 20th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care. In December 2013, AJMC launched The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in the areas of oncology, diabetes management, respiratory care, and immunology and infectious disease.

Mary Caffrey (609) 716-7777 x 144


  • Mary Caffrey
    American Journal of Managed Care
    +1 609-731-8802