Do Clinical Pathways Inhibit Cancer Care?

by Amanda Conschafter, blog editor

Clinical pathways could be the route to less transparent, more restricted cancer care. Nearly two dozen cancer advocacy organizations argued as much in a recent letter to national and state insurance commissioners, explaining that incentivizing physicians to favor less expensive treatment options could weaken the physician-patient relationship. Equally concerning, they noted, it could also result in sub-optimal care.

Clinical pathways promote the use of stipulated therapies, sometimes in a specified order, to streamline patient care and reduce costs. Insurers encourage the practice increasingly for the care of cancer, where life-saving treatments can carry hefty price tags. By offering a financial incentive for physicians to follow clinical pathways, insurers can encourage greater participation and generate substantial cost-savings.

But, as the National Patient Advocate Foundation notes, this arrangement isn’t always transparent. “Patients have the right to know,” the letter’s signers agree, “if their doctors are participating in programs that provide monetary rewards for selecting from a narrow range of treatment options.” Without transparency the use of clinical pathways can undermine “the trust between a physician and a patient,” a cornerstone of quality care.

Clinical pathways may also exclude “commonly covered and clinically effective treatment options,” potentially to the patient’s detriment. Narrowing the range of treatment options could have an “unintended consequence” – treatment that doesn’t reflect individual patients’ best interests, signers acknowledge.

Urging transparency and unrestricted access to approved therapies, NPAF surmises that “patients will be far better served through policies that reward improvements in patient health outcomes rather than those that reward restrictions in patient choice.”


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