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Publications
  • February 2018
  • Article
  • Journal of Oncology Practice

Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program

By: Tracy Spinks, Alexis Guzman, Beth M. Beadle, Seohyun Lee, Ron Walters, Jim Incalcaterra, Ehab Hanna, Amy Hessel, Randal Weber, Sandra Denney, Lee Newcomer and Thomas W. Feeley
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Abstract

Purpose: Despite growing interest in bundled payments to reduce the costs of care, this payment method remains largely untested in cancer. This 3-year pilot tested the feasibility of a 1-year bundled payment for the multidisciplinary treatment of head and neck cancers.

Methods: Four prospective treatment-based bundles were developed for patients with selected head and neck cancers. These risk-adjusted bundles covered 1 year of care that began with primary cancer treatment. Manual processes were developed for patient identification, enrollment, billing, and payment. Patients were prospectively identified and enrolled, and bundled payments were made at treatment start. Operational metrics tracked incremental effort for pilot processes and average payment cycle time compared with fee-for-service (FFS) payments.

Results: This pilot confirmed the feasibility of a 1-year prospective bundled payment for head and neck cancers. Between November 2014 and October 2016, 88 patients were enrolled successfully with prospective bundled payments. Through September 2017, 94% of patients completed the pilot with 6% still enrolled. Manual pilot processes required more effort than anticipated; claims processing was the most time-consuming activity. The production of a bundle bill took an additional 15 minutes versus FFS billing. The average payment cycle time was 37 days (range, 15 to 141 days) compared with a 15-day average under FFS.

Conclusion: Prospective bundled payments were successfully implemented in this pilot. Additional pilots should study this payment method in higher-volume cancers. Robust systems are needed to automate patient identification, enrollment, billing, and payment along with policies that reduce administrative burden and allow for the introduction of novel cancer therapies.

Keywords

Health Care and Treatment; Cost Management

Citation

Spinks, Tracy, Alexis Guzman, Beth M. Beadle, Seohyun Lee, Ron Walters, Jim Incalcaterra, Ehab Hanna, Amy Hessel, Randal Weber, Sandra Denney, Lee Newcomer, and Thomas W. Feeley. "Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program." Journal of Oncology Practice 14, no. 2 (February 2018): e103–e121.
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More from the Authors

    • November 2021
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    Determining Variable Costs in the Acute Urolithiasis Cycle of Care Through Time-driven Activity-based Costing

    By: Tyler R. McClintock, David F. Friedlander, Aiden Y. Feng, Mahek A. Shah, Daniel J. Pallin, Steven L. Chang, Angela M. Bader, Thomas W. Feeley, Robert S. Kaplan and George E. Haleblian
    • June 2021
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    Developing a Value Framework: Utilizing Administrative Data to Assess an Enhanced Care Initiative

    By: Casey J. Allen, Jarrod S. Eska, Nikhil G. Thaker, Thomas W. Feeley, Robert S. Kaplan, Ryan W. Huey, Ching-Wei D. Tzeng, Jeffrey E. Lee, Steven J. Frank, Thomas A. Aloia, Vijaya Gottumukkala and Matthew H.G. Katz
    • May 2021
    • European Urology

    Value-Based Healthcare in Urology: A Collaborative Review

    By: Chanan Reitblat, Paul A. Bain, Michael E. Porter, David N. Bernstein, Thomas W. Feeley, Markus Graefen, Santosh Iyer, Matthew J. Resnick, C.J. Stimson, Quoc-Dien Trinh and Boris Gershman
More from the Authors
  • Determining Variable Costs in the Acute Urolithiasis Cycle of Care Through Time-driven Activity-based Costing By: Tyler R. McClintock, David F. Friedlander, Aiden Y. Feng, Mahek A. Shah, Daniel J. Pallin, Steven L. Chang, Angela M. Bader, Thomas W. Feeley, Robert S. Kaplan and George E. Haleblian
  • Developing a Value Framework: Utilizing Administrative Data to Assess an Enhanced Care Initiative By: Casey J. Allen, Jarrod S. Eska, Nikhil G. Thaker, Thomas W. Feeley, Robert S. Kaplan, Ryan W. Huey, Ching-Wei D. Tzeng, Jeffrey E. Lee, Steven J. Frank, Thomas A. Aloia, Vijaya Gottumukkala and Matthew H.G. Katz
  • Value-Based Healthcare in Urology: A Collaborative Review By: Chanan Reitblat, Paul A. Bain, Michael E. Porter, David N. Bernstein, Thomas W. Feeley, Markus Graefen, Santosh Iyer, Matthew J. Resnick, C.J. Stimson, Quoc-Dien Trinh and Boris Gershman
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