Title: Getting the Next Version of Payment Policy “Right” on the Road Toward Accountable Cancer Care
Abstract: The economist's view of physician behavior is one in which the practice of medicine is motivated by tradeoffs among income, conscience, and leisure, with perhaps a nod to training or practice norms ( 1 Reinhardt U.E. The economist's model of physician behavior. JAMA. 1999; 281: 462-465 Crossref PubMed Scopus (30) Google Scholar ). As much as physicians might find such a caricature distasteful and inconsistent with their core beliefs and practices, empirical evidence supports the basic elements of this model of physician behavior ( 2 Chandra A. Cutler D.M. Song Z. Who ordered that? The economics of treatment choices in medicare care. in: Handbook of Health Economics. Vol 2. Elsevier, New York2012 Google Scholar ). Moreover, policy makers have relied on this model to develop physician payment policies that attempt to balance the interests of physicians, patients, and payers. Design and Implementation of Bundled Payment Systems for Cancer Care and Radiation TherapyInternational Journal of Radiation Oncology, Biology, PhysicsVol. 89Issue 5PreviewFrom 2003 to 2009, radiation oncology exceeded its sustainable growth rate target by nearly 300% (1). Between 2010 and 2011, the intensity modulated radiation therapy (IMRT) code exhibited the fourth highest percent increase of all Medicare codes (2). It is difficult to determine the extent to which this spending growth has produced commensurate clinical benefit, but the current payment system raises concerns about overutilization. Hospitals and clinics are reimbursed for each discrete element of care, and the technological focus of radiation oncology generates an abundance of billable units. Full-Text PDF