Ms. Buchsel, in summarizing the discussion on this topic, highlighted economic strategies to encourage care planning. She stated that reimbursement for completing the care plan template is likely to be insufficient for physician time spent on this activity. Having nurses, clinical research associates, or other trained nonphysicians complete some portions of the care plan would make it feasible from a cost standpoint. Having others involved in its completion may actually result in higher quality data, she noted. Another group member mentioned that oncologists cannot reliably report tumor-node-metastasis (TNM) staging.
According to Ms. Buchsel, incentives to adopt care planning could include: (1) ASCO endorsement of care planning as an expected standard of care; and (2) adoption of care planning as a quality indicator that could be used as part of report card-type quality improvement programs or pay for performance initiatives. Patients and referring physicians may start choosing practices in which care planning is offered.
Insurers have started to ask for preauthorization for chemotherapy, and this practice is going to become common as the cost of cancer drugs escalates. If the treatment plan could be used to fulfill the preauthorization documentation, then providers might be very interested in completing the treatment summary. The prospective plan for follow-up could also be considered for preauthorization. Oncology providers could, for example, list the imaging procedures and tests recommended for the next 3 years and, if approved, could meet the preauthorization requirements prospectively. This could save significant office time and resources. If the template were standardized and confined to one page, all insurers would be likely to want to use it.
Members of Group 6 discussed barriers to care planning, focusing on how they might be overcome. In terms of solutions, the notion of keeping it simple was reiterated by several group members. A minimum standard, not the best that there could be, should be designated for the treatment summary and the prospective care plan. To expedite care planning, group members thought that starting with a few cancers, for example, breast and colon cancer, would be advisable because surveillance and risk guidelines are already available. Advisable also is learning from the pediatric experience with survivorship guidelines and innovative strategies to communicate with survivors and their providers (see the discussion of the Passport for