Whether driven primarily by guideline revisions, regulatory actions, or changes in reimbursement policies, changes in clinical practice result primarily from the generation of new medical evidence through well-designed research studies and from the commitment of every oncologist to deliver the highest quality care to his or her patients.
—Richard L. Schilsky, MD
Information on the drivers of cancer care is important in helping to deliver higher-quality and potentially less costly cancer treatments, noted Richard L. Schilsky, MD, ASCO’s Chief Medical Officer, in a commentary accompanying the study by Dotan et al.1 Moreover, practice change can be a complex process, and there is probably more to the story than the three important factors pointed out by the investigators, he wrote.
More to the Story
While new medical evidence is fundamental to practice change, it may take a year or two for policy to recalibrate, Dr. Schilsky said in an interview with The ASCO Post. And during that time, there is uncertainty, which makes life complicated for many parties—clinicians, pharmaceutical companies, laboratories, insurers, and others.
The reimbursement policies of different insurers, for instance, may begin to change following new data. That almost certainly was the case with KRAS testing and the use of cetuximab (Erbitux) and panitumumab (Vectibix), Dr. Schilsky wrote. For instance, Aetna announced a policy change in April 2009, and a local Medicare carrier in Florida announced a change in February 2009—both in line with the ASCO guidance.
Rates of change may also depend on the clinical context. In this case, one factor could have been how quickly KRAS tests became available. After the ASCO presentation, many laboratories began to develop their own tests, but it was a year before a U.S. Food and Drug Administration–approved test became available.
Other potential drivers of practice change, Dr. Schilsky wrote, are quality assessment and improvement activities, including changes in requirements for provider licensing or certification. Also, public reporting of physician reimbursement or transfers of value from pharmaceutical companies to physicians, such as required by the Physician Payments Sunshine Act, may contribute.
“The effect may be subtle,” he said, “but there is increased awareness that some interactions of clinicians with pharmaceutical companies are now subject to public reporting. These kinds of things can affect behavior.”
Regardless of which factors play a role, the fundamental drivers remain the same. “Whether driven primarily by guideline revisions, regulatory actions, or changes in reimbursement policies,” Dr. Schilsky wrote, “changes in clinical practice result primarily from the generation of new medical evidence through well-designed research studies and from the commitment of every oncologist to deliver the highest quality care to his or her patients.” n
Disclosure: Dr. Schilsky is Chief Medical Officer of ASCO.
1. Schilsky RL: Drivers of change in cancer care. J Oncol Pract. July 22, 2014 (early release online).