ideasIdea
Pay oncologists for the time it takes to enrol a patient
Discussing and enrolling a patient in a trial takes an oncologist far longer than prescribing the usual treatment, and they are not paid for it. Paying for that time would remove a quiet disincentive.
Health systems and payers create a reimbursable code or protected-time allocation for trial discussion and enrolment (analogous to advance-care-planning codes), and sponsors' per-patient budgets include physician time explicitly rather than folding it into overhead. Academic promotion criteria count enrolment.
Hypothesis
Practices where physician enrolment time is paid or protected will have higher enrolment per oncologist than matched practices without it.
Rationale
Physician recommendation is the strongest predictor of enrolment, and time pressure is the most cited reason oncologists do not offer trials. Payment for cognitive services changes behaviour in other settings.
What would test it
A health system introduces a trial-discussion payment for half its oncology practices for 18 months and compares enrolment per physician.
Maturity
speculative
Who has to act
payer
Cost to try
Medium ($1M to $50M)
Years to first evidence
2
Bottlenecks it attacks
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.
- Incentives reward me-too drugs and marginal gains · The system pays the same for a drug that adds two months as for a cure, so companies race to copy rather than to cure.