Oncologists Call for Greater Physician Involvement in Oncology Clinical Pathway Development


In a commentary published online, oncologists from the University of Chicago (Chicago, IL) and the Center for Cancer and Blood Disorders (Ft Worth, TX) argued that their colleagues should take a more active role in the development of clinical pathways for cancer care and that governmental oversight of clinical pathways programs is needed to ensure their quality.

Clinical pathways have proven to be an efficient method for improving treatment outcomes and reducing health care costs; however, many have expressed concern about the rapid and often forced adoption of so many different pathways programs. This concern is mostly targeted at payer-developed pathways, which offer incentives to providers for administering treatments that are preauthorized by the insurer. Yet, with each payer developing different pathways for the same disease state, health care providers face a profound administrative burden associated with managing treatments for patients with the same disease but differing insurance coverage.

In an article published in JAMA Oncology, Blase N Polite, MD, MPP (University of Chicago, IL) and coauthors described some solutions that might address the concerns of all stakeholders regarding the use of clinical pathways in oncology. First, they assert that physicians are best positioned to develop pathways that meet the needs of patients and health care institutions. Payer-developed pathways, the authors claim, often are biased towards the goal of improving costs. Ideally, pathway development would involve conversations among the entire physician community, reduce the variability of health care, and encourage shared-decision making through the doctor–patient relationship.

Second, the authors suggest that the government should implement a system to verify and approve pathways created by physicians and health care institutions. Payers should then be required to offer reimbursement for any services provided in accordance with any of the government-approved pathways. Such a policy would create a “checks and balances” system for pathway development and alleviate the concerns of many providers. Physicians would be able to design and use pathways that include their preferred treatments, and—if the government agrees that their pathways are evidence-based—that would be covered by all payers.

The authors concluded by warning that clinical pathways initiatives are not likely to succeed unless action is taken to alleviate administrative burden and protect physician agency.