UnitedHealth tests ending fee-for-service chemo

Caring4Cancer ^ | October 20, 2010 | Lewis Krauskopf

[JustSurrounded]

NEW YORK (Reuters) - UnitedHealth Group Inc is trying to change how it reimburses oncologists using a method the insurer says could improve treatment practices.

The U.S. health insurer has started a pilot program involving five physician practices across the country, focusing on breast, colon and lung cancers, the company announced on Wednesday.

Oncologists currently buy chemotherapies and other drugs directly at wholesale prices, and then are reimbursed at higher retail rates, UnitedHealth said.

Oncologists make about 60 percent of their income from selling drugs in this way, according to UnitedHealth, the largest health insurer by market value. They may make greater profit margins from higher-priced medicines, and therefore can be incentivized to prescribe newer drugs regardless if they have been proven more effective.

As opposed to this fee-for-service method, doctors in the pilot program will be paid one upfront fee based on the expected cost of a standard treatment regimen.

Lee Newcomer, UnitedHealthcare's senior vice president for oncology said that by paying oncologists for a patient's total cycle of treatment, rather than the number of visits and the amount of chemotherapy drugs given, the program promotes better, more patient centric care with no loss of revenue for the physician.

[JustSurrounded]

So, a flat fee, regardless of number of visits to the doctor or treatment selected, is going to promote 'better, more patient centric care'? Right. And we get the 'no loss of revenue for the physician' because now the doc will get paid whether he bothers to follow up appropriately with the patient.

Seems every time government or insurance steps in, the patient suffers.

[Zathras]

For those who don’t know, United Healthcare is run by SEIU on both the east and west coasts.

[Still Thinking]

Exactly. Normally, I favor letting industries regulate themselves because the result, while imperfect, is usually better than what you'd get if know-nothing bureaucrats were in charge of the regs.

But the insurance industry is unique in that they seem to have a business model based on the government: Give us a bunch of money, then WE make your decisions for you.

So yes, the industry needs reform, but not MORE government intrusion, the things we hate about them are because they're too government-like NOW. The answer is to abolish insurance for normal use and give everyone HSA's in conjunction with a catastrophic policy, so the insurers aren't even involved 99% of the time. Or just remove healthcare's special status and make it all after-tax again like before WWII (with corresponding across-the-board rate reductions so it doesn't put more money in undeserving government hands).

[JayGalt]

Wow! It is scary than they are trying to convince us that letting the doctors make a profit only if they use cheaper drugs and see us less will give us better healthcare. What’s worse is selling patients down the river while pretending concern for patients and pretending to protect them from rapacious doctors. Usually they are satisfied forbidden the doctors from prescribing the latest, most expensive and often most efficacious drugs while requiring the doctors not to let the patients know those drugs exist. That method also gives doctors a financial interest in denying care or warehousing patients rather than referring.

That has been the US Healthcare game all along. Another game is insuring lives not services, passing the risk of a patient needing extra followup care or more tests onto doctors who are ill equip to quantify their potential downside and getting a fixed cost for the insurance company. When they have driven enough doctors out of business they know their bundled rate is low enough. If patients suffer along the way its not the insurance company’s problem. Ms Clinton injected big business into the healthcare system and we have been paying the price ever since.