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Over the past decade, the oncology community has generated a tremendous amount of evidence on the multitude of benefits of embedding supportive health care delivery interventions within clinical workflows of oncology providers.1-5 Despite the undeniable improvements in cost, quality, and patient experience, these programs, including formalized lay navigation and psychosocial support as well as proactive symptom evaluation with protocolized nurse triage services, are difficult to sustain and scale in our legacy fee-for-service system, particularly for community oncology practices.
First and foremost, oncology practices lack the capital to invest in additional staff, information technology, and change management to optimize and maintain this type of supportive care program. Even with new Medicare reimbursement for a handful of these services, the attainable revenue from these codes falls well short of the cost to stand up the program and deliver the services. Practices must find other ways to finance these services, typically by cross-subsidization of drug revenue or through philanthropy, while the financial benefits accrue to the payers in the form of spend reduction.
Although oncology practices are doing everything in their power to meet the needs of their complex patient population, the practical reality is that this incentive misalignment threatens the feasibility of providing essential services to patients when they need them. Making matters worse, practices are facing increasingly significant financial headwinds from continued reductions in cancer drug reimbursement from both commercial payers and Medicare via the Inflation Reduction Act.