Advertisement

Society of gynecologic oncology future of physician payment reform task force: Lessons learned in developing and implementing surgical alternative payment models

Published:January 13, 2020DOI:https://doi.org/10.1016/j.ygyno.2019.12.036

      Highlights

      • Gynecologic oncologists are experimenting with a variety of different alternative payment models (APMs).
      • There are many challenges associated with developing new APMs in gynecologic oncology.
      • Implementation challenges include stakeholder engagement, attribution, risk adjustment, and quality measurement.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gynecologic Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • National Cancer Institute Cancer Prevalence and Cost of Care Projections
        (Available at)
        • Carrera P.M.
        • Kantarjian H.M.
        • Blinder V.S.
        The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment.
        CA Cancer J. Clin. 2018; 68: 153-165
        • Liang M.I.
        • Huh W.K.
        Financial toxicity – an overlooked side effect.
        Gynecol. Oncol. 2018; 150: 3-6
        • Ganz P.A.
        Institute of Medicine report on delivery of high-quality cancer care.
        J Oncol Pract. 2014; 10: 193-195
        • Porter M.E.
        What is value in health care?.
        N. Engl. J. Med. 2010; 363: 2477-2481
        • Aviki E.M.
        • Schleicher S.M.
        • Mullangi S.
        • et al.
        Alternative payment and care-delivery models in oncology: a systematic review.
        Cancer. 2018; 124: 3293-3306
        • Alvarez R.A.
        • Gray H.J.
        • Timmins P.F.
        • et al.
        We need a new paradigm in gynecologic cancer care: SGO proposes solutions for delivery, quality and reimbursement policies.
        Gynecol. Oncol. 2013; 129: 3-4
        • Ko E.M.
        • Havrilesky L.J.
        • Alvarez R.D.
        • et al.
        Society of gynecologic oncology future of physician payment reform task force report: the Endometrial Cancer Alternative Payment Model (ECAP).
        Gyncol Oncol. 2018; 149: 232-240
        • Centers for Medicare and Medicaid Servies
        MACRA.
        (Updated June 14, 2019. Available at)
      1. 114th congress. H.R.2 - Medicare access and CHIP reauthorization act of 2015.
        (Updated April 16, 2015. Available at)
        • Commission on Cancer of the American College of Surgeons and American Cancer Society
        National Cancer Database (NCDB).
        (Updated 2019. Available at)
        • Dewdney S.B.
        • Dancisak A.C.
        • Lachance J.A.
        • et al.
        Society of Gynecologic Oncology Clinical Outcomes Registry: from small beginnings come great things.
        Gynecol. Oncol. 2018; 148: 439-444
      2. Truven health analytics MarketScan research database.
        (Updated December 2017. Available at)
        • Wright J.D.
        • Havrilesky L.J.
        • Cohn D.E.
        • et al.
        Estimating potential for savings for low risk endometrial cancer using the Endometrial cancer Alternative Payment model (ECAP): a companion paper to the Society of Gynecologic Oncology Report on the Endometrial Cancer Alternative Payment model.
        Gynecol. Oncol. 2018; 149: 241-247
        • Gemignani M.L.
        • Curtin J.P.
        • Zelmanovich J.
        • et al.
        Laparoscopic-assisted vaginal hysterectomy for endometrial cancer: clinical outcomes and hospital charges.
        Gynecol. Oncol. 1999; 73: 5-11
        • Bijen C.B.
        • Vermeulen K.M.
        • Mourits M.J.
        • et al.
        Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: a randomised trial.
        Gynecol. Oncol. 2011; 121: 76-82
        • Schiavone M.B.
        • Herzog T.J.
        • Ananth C.V.
        • et al.
        Feasibility and economic impact of same-day discharge for women who undergo laparoscopic hysterectomy.
        Am. J. Obstet. Gynecol. 2012; 207: 382 e1-9
        • Nahas S.
        • Feigenberg T.
        • Park S.
        Feasibility and safety of same-day discharge after minimally invasive hysterectomy in gynecologic oncology: a systematic review of the literature.
        Gynecol. Oncol. 2016; 143: 439-442
        • Lee J.
        • Aphinyanaphongs Y.
        • Curtin J.P.
        • et al.
        The safety of same-day discharge after laparoscopic hysterectomy for endometrial cancer.
        Gynecol. Oncol. 2016; 142: 508-513
        • Warren L.
        • Ladapo J.A.
        • Borah B.J.
        • et al.
        Open abdominal versus laparoscopic and vaginal hysterectomy: analysis of a large United States payer measuring quality and cost of care.
        J. Minim. Invasive Gynecol. 2009; 16: 581-588
        • Wright J.D.
        • Ananth C.V.
        • Lewin S.N.
        • et al.
        Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease.
        JAMA. 2013; 309: 689-698
        • Dessources K.
        • Hou J.Y.
        • Tergas A.I.
        • et al.
        Factors associated with 30-day hospital readmission after hysterectomy.
        Obstet. Gynecol. 2015; 125: 461-470
        • Fader A.N.
        • Arriba L.N.
        • Frasure H.E.
        • et al.
        Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship.
        Gynecol. Oncol. 2009; 114: 121-127
        • National Comprehensive Cancer Network
        NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Uterine Neoplasm.
        (Version 3.2019. Udated February 11, 2019. Available at)
        • Ward K.K.
        • Shah N.R.
        • Saenz C.C.
        • et al.
        Cardiovascular disease is the leading cause of death among endometrial cancer patients.
        Gynecol. Oncol. 2012; 126: 176-179
        • Classen D.C.
        • Evans R.S.
        • Pestotnik S.L.
        • et al.
        The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection.
        N. Engl. J. Med. 1992; 326: 281-286
        • Geerts W.H.
        • Bergqvist D.
        • Pineo G.F.
        • et al.
        Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition).
        Chest. 2008; 133: 381S-453S
        • Galaal K.
        • Bryant A.
        • Fisher A.D.
        • et al.
        Laparoscopy versus laparotomy for the management of early stage endometrial cancer.
        Cochrane Database Sysy Rev. 2012; 9CD006655
        • Malzoni M.
        • Tinelli R.
        • Cosentino F.
        • et al.
        Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study.
        Gynecol. Oncol. 2009; 112: 126-133
        • Walker J.L.
        • Piedmonte M.R.
        • Spirtos N.M.
        • et al.
        Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group study LAP2.
        J. Clin. Oncol. 2009; 27: 5331-5336
        • Zullo F.
        • Palomba S.
        • Falbo A.
        • et al.
        Laparoscopic surgery vs laparotomy for early stage endometrial cancer: long-term data of a randomized controlled trial.
        Am. J. Obstet. Gynecol. 2009; 200: 296 e1-9
        • Centers for Medicare and Medicaid Servies
        2016 physician quality reporting system (PQRS) implementation guide.
        (Updated July 13, 2016. Available at)
        • Connor J.P.
        • Andrews J.I.
        • Anderson B.
        • et al.
        Computed tomography in endometrial carcinoma.
        Obstet. Gynecol. 2000; 95: 692-696
        • Novetsky A.P.
        • Kuroki L.M.
        • Massad L.S.
        • et al.
        The utility and management of vaginal cytology after treatment for endometrial cancer.
        Obstet. Gynecol. 2013; 121: 129-135
        • Salani R.
        • Backes F.J.
        • Fung M.F.
        • et al.
        Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations.
        Am. J. Obstet. Gynecol. 2011; 204: 466-478
        • Office of the Asssistant Secretary for Planning and Evaluation
        Physician-Focused Payment Model Technical Advisory Committee (PTAC).
        (Updated January 2, 2019. Available at)
        • Uppal S.
        • Penn C.
        • del Carmen M.
        • et al.
        Readmissions after major gynecologic oncology surgery.
        Gynecol. Oncol. 2016; 141: 287-292
        • Rolston A.
        • Spencer R.J.
        • Reynolds K.
        • et al.
        Factors associated with outcomes and inpatient 90-day cost of care in endometrial cancer patients undergoing hysterectomy - implications for bundled care payments.
        Gynecol. Oncol. 2018; 150: 106-111
        • Penn C.A.
        • Morgan D.M.
        • Rice L.W.
        • et al.
        Timing of and reasons for unplanned 30-day readmission after hysterectomy for benign disease.
        Obstet. Gynecol. 2016; 128: 889-897
      3. Opelka F., Coffron M., Proposal for a Physician-Focused Payment Model: ACS-Brandeis Advanced Alternative Payment Model. American College of Surgeons. Updated December 13, 2016. Available at: https://aspe.hhs.gov/system/files/pdf/253406/TheACSBrandeisAdvancedAPM-ACS.pdf. Accessed August 27, 2018.

        • Barber E.L.
        • Rossi E.C.
        • Alexander A.
        • et al.
        Benign hysterectomy performed by gynecologic oncologists: is selection bias altering our ability to measure surgical quality?.
        Gynecol. Oncol. 2018; 151: 141-144
        • Janda M.
        • Gebski V.
        • Brand A.
        • et al.
        Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomized trial.
        Lancet Oncol. 2010; 11: 772-780
        • Mourits M.J.
        • Bijen C.B.
        • Arts H.J.
        • et al.
        Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomized trial.
        Lancet Oncol. 2010; 11: 763-771
        • Rossi E.C.
        • Kowalski L.D.
        • Scalici J.
        • et al.
        A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicenter, prospective cohort study.
        Lancet Oncol. 2017; 18: 384-392
        • Revenig L.M.
        • Canter D.J.
        • Taylor M.D.
        • et al.
        Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predicting of poor surgical outcomes.
        J. Am. Coll. Surg. 2013; 217: 665-670
        • American College of Surgeons
        ACS National Surgical Quality Improvement Project.
        (Updated March 25, 2019. Available at)
        • Centers for Medicare and Medicaid Services
        Comprehensive Care for Joint Replacement Model.
        (Updated July 15, 2019. Available at)
        https://innovation.cms.gov/initiatives/CJR
        Date accessed: July 30, 2019
        • Centers for Medicare and Medicaid Services
        Bundled payments for care improvement advanced model.
        (Updated June 28, 2019. Available at)
        • American College of Obstetricians and Gynecologists
        ACOG Committee opinion no. 747 summary: gynecologic issues in children and adolescent cancer patients and survivors.
        Obstet. Gynecol. 2018; 132: 535-536
        • American College of Obstetricians and Gynecologists
        ACOG Committee opinion no. 774: opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention.
        Obstet. Gynecol. 2019; 133: 842-843
        • American College of Obstetricians and Gynecologists
        Committee opinion no. 701 summary: choosing the route of hysterectomy for benign disease.
        Obstet. Gynecol. 2017; 129: 1149-1150
        • Parker W.H.
        • Feskanich D.
        • Broder M.S.
        • et al.
        Long-term mortality associated with oophorectomy compared with ovarian conservation in the nurses’ health study.
        Obstet. Gynecol. 2013; 121: 709-716
        • Mytton J.
        • Evison F.
        • Chilton P.J.
        • et al.
        Removal of all ovarian tissue versus conserving ovarian tissue at time of hysterectomy in premenopausal patients with benign disease: study using routine data and data linkage.
        BMJ. 2017; 356: j372
        • American College of Surgeons
        S-CAHPS (consumer assessment of healthcare providers and systems surgical care survey).
        (Updated October 1, 2011. Available at)
        https://www.facs.org/advocacy/quality/cahps
        Date accessed: August 2, 2019
        • Centers for Medicare and Medicaid Services
        Oncology care model.
        (Updated August 2, 2019. Available at)
        • Agency for Healthcare Research and Quality
        CAHPS (Consumer Assessment of Healthcare Providers and Systems).
        (Available at)
        https://www.ahrq.gov/cahps/index.html
        Date accessed: August 17, 2019
        • American Society of Clinical Oncology
        Patient-centered oncology payment: payment reform to support higher quality, more affordable cancer care.
        (Updated May 2015. Available at)
        • Innovative Oncology Business Solutions Inc
        MASON - making accountable sustainable oncology networks.
        (Updated February 18, 2018. Available at)
        • Centers for Medicare and Medicaid Services
        Radiation oncology model.
        (Updated August 7, 2019. Available at)