Reimbursement Trends in Clinical Oncology: Payment and Quality Issues

The 1980 Graduate Medical Education National Advisory Committee (GMENAC) study projected that by the year 1990 a shortage of 700 hematologists/oncologists would exist in this country (1). Subsequent estimates indicate manpower needs will be met by certified specialists and, if one includes noncertified specialists a surplus will exist in the near future (2). In addition to increased competition for patients, oncologists face changes in traditional third-party and governmental reimbursement policies as well as the proliferation of such managed care systems as health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Such changes are altering the amounts, timeliness, and methods of physician reimbursement. Aside from concerns about personal payment, oncologists may wonder if such changes will affect the quality of patient care. This article discusses methods of payment for the oncologist's services and the implications that changes in the current system may have on quality of care. Because the managed care systems mentioned above (especially HMOs) provide the greatest challenge to traditional oncology practice, more discussion will be devoted to that topic than to traditional payment methods.