In order to address the oncologist’s perspective on clinical pathways, James N Frame, MD, FACP, Charleston Area Medical Center, talked about some of the concerns that oncology care providers have about using clinical pathways.
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Dr Frame asserted that practitioners recognize the value of pathways but have concerns about their implementation.
Practitioner concerns about clinical pathways were first raised to ASCO by the State Affiliate Council in October 2014, he said. The concerns raised by members were that pathways: were uncoordinated and coming too fast to understand their impact; were too restrictive and based on evidence of insufficient quality; were designed with no transparency, making it difficult to know whether there were any conflicts of interest; lacked provider input; and were too numerous for practices to handle. On this last point, Frame noted that some practices must follow as many as 5-10 clinical pathways for their patients, and pre-authorization requirements make it difficult and time-consuming—sometimes requiring 2 weeks—to get treatments approved.
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In parallel with the Clinical Pathways Task Force, the State Affiliate Council has also been acting to gain a better understanding of clinical pathways. In particular, a survey was conducted of practitioners in the US regarding pathways use. Half of respondents said that they are currently using pathways. Notably, a large percentage did not know whether or not they were using pathways. A total of 79% said that they likely would use clinical pathways if they were provider developed.
With regards to the effect of clinical pathways on reimbursement and administrative burden, some respondents said that pathways streamline the prior authorization process, but others said that they complicate the process. There were much fewer reports of positive aspects for payer-developed pathways than for provider-developed pathways. Dr Frame suggested that providers likely resent the idea of payers driving treatment decisions.
When asked how ASCO should proceed, 93% asked ASCO to define the characteristics of quality pathways, 87% supported a certification program for pathways, and 71% wanted ASCO to develop their own pathways. Overall, the survey findings revealed that concerns differed for payer- and provider-developed pathways.
