Bundled Payments for Breast Cancer Care Improve Outcomes, Controls Costs
Results of a pilot payment program implemented in Taiwan suggest that bundling payments in a program based on pay-for-performance (PFP) for breast cancer care may lead to better adherence to quality indicators, better outcomes, and over time be more effective at controlling costs.
Given the scant data on bundled payment for oncologic conditions in the United States, these results may shed some light on how such a payment program may affect healthcare outcomes in the US as it shifts away from the traditional fee-for-service (FFS) payment model to episode-based bundled payments.
In the study, C. Jason Wang, MD, PhD, Center for Health Policy/Primary Care Outcomes Research, Stanford University School of Medicine, and colleagues examined outcomes and medical expenditures associated with a bundled payment PFP program for breast cancer and compared them to a FFS payment program.
The investigators used data from the Taiwan Cancer Database to identify 17,940 women with newly diagnosed breast cancer who had undergone a first cancer treatment between January 1, 2004 and December 31, 2008, and were followed for 5 years. Of the 17,940 women, 4485 (25%) were enrolled in a bundled-payment program and 13,455 (75%) in FFS program.
______________________________________________________________________________________________________________________________________________
RELATED CONTENT
Can Contraceptives Spark Depression?
Antipsychotic Response in Schizophrenia Worsens With Menopause
______________________________________________________________________________________________________________________________________________
The main outcomes of the study were rates of adherence to quality indicators, survival rates, and medical payments (which did not include bonuses paid in the bundled-payment program group).
The study found that patients in the bundled-payment program had better adherence to applicable quality indicators than those in the FFS program, as well as better 5-year survival rates.
Of 4215 patients with applicable quality indicators in the bundled-payment group, 1473 (34.9%) achieved 100% adherence to quality indicators compared to 3438 of 12506 (27.5%) patients in the FFS group (P<.001).
For patients with 0 to III stage breast cancer, the 5-year survival rates were 84.4% versus 80.88% for the bundled-payment group and FFS group, respectively (P<.01).
Regarding cost, the study found that the medical payments of the bundled-payment group remained stable at 5 years. However, cumulative medical payments steadily increased from $16,000 to $19.230 for the FFS group and exceeded PFP bundled payments starting in 2008.
“Our study demonstrated that PFP bundled payment for breast cancer care may contribute to cost containment, better adherence to quality care, and improved outcomes,” state the study authors.
Commenting on the study in an editorial accompanying the study, Lee N. Newcomer, MD, UnitedHealthcare, Minnetonka, MN, said that the study shows “there are viable solutions to reduce costs while simultaneously providing high-quality care to patients.”
“Physicians practicing in the United States can be encouraged by this effort as they begin their own participation in program that measure cost and quality,” he said. —Mary Beth Nierengarten
References
1. Wang CJ, Cheng SH, Wu JY, et al. Association of a bundled-payment program with cost and outcomes in full-cycle breast cancer care. JAMA Oncol. doi:10.1001/jamaoncol.2016.4549 Published online October 20, 2016.
2. Newcomer LN. Better outcomes for lower costs in breast cancer care: finding a way. Published Online: October 20, 2016. doi:10.1001/jamaoncol.2016.4544.
