Policy Statement on Site-Neutral Payments in Oncology (ASCO)

Policy Statement

 American Society of Clinical Oncology⇑

1. Corresponding author: American Society of Clinical Oncology

1. Presented to American Society of Clinical Oncology (ASCO) State Affiliate Council Executive Subcommittee Leadership: December 2015; ASCO Clinical Practice Committee Leadership: December 2015; ASCO Government Relations Committee: February 2015; ASCO Full Board of Directors (for final approval): May 2015.

INTRODUCTION

The phrase site neutrality is commonly used to describe efforts to reconcile payment differentials for the same or similar health care services provided in different settings of care. Under the fee-for-service Medicare program, the two dominant payment systems for oncology services—the Medicare physician fee schedule and the hospital outpatient prospective payment system—are based on different rate-setting methodologies. The differences in these rate-setting methodologies can result in different payment levels for similar or identical health care services.

In response to these differences in payment levels, some stakeholders and policymakers—including the Medicare Payment Advisory Commission (MedPAC), members of Congress, and the Centers for Medicare and Medicaid Services (CMS)—have proposed but not implemented various options for establishing site neutrality.^1-3 These site-neutrality proposals are focused on reducing Medicare payment levels in one setting of care without examining whether such modified payments would adequately meet the needs of Medicare beneficiaries with cancer in that setting. Furthermore, these site-neutrality proposals are based on the existing, outdated coding and reimbursement system, without accounting for the potential adverse impacts on the ongoing efforts to fundamentally reform the oncology delivery system or the overarching trend toward value-based payment models in all settings of care......