Transitioning from a Fee-for-Service Model to the Oncology Medical Home Improves Patient Outcomes

Meg Barbor, MPH

November 2016, Vol 6, No 11 - ACCC Conference Highlights


“To be independent, you must be dependent on others,” said Ray Page, DO, PhD, FACOI, President, Center for Cancer and Blood Disorders, Weatherford, TX, at the 2016 Association of Community Cancer Centers’ National Oncology Conference.

According to Dr Page, good patient care requires a team approach, and becoming an Oncology Medical Home means better care for patients, lower spending for payers, and more financially viable physician practices.

Dr Page’s practice participated in the Community Oncology Medical Home (COME HOME) program led by Barbara L. McAneny, MD, from Innovative Oncology Business Solutions, which used a $19.8-million Center for Medicare and Medicaid Innovation grant to implement Oncology Medical Home structures in 7 practices across the United States.

The program focused on utilizing centralized, protocol-driven triage nurses, expanding office and clinic hours, developing treatment pathways, and improving laboratory and molecular diagnostics efficiency.

“Under the Oncology Medical Home structure, we turned our practice upside down, and took it to a whole different level of patient care,” said Dr Page.

Patient Engagement in Value-Based Models

With the numerous external pressures being put on independent oncology practices—including the new MACRA (Medicare Access and CHIP Reauthorization Act) legislation, 340B drug pricing, site-neutrality issues creating disparity, US Pharmacopeial (USP) Convention 797 and UPS 800 guidelines, erosion of the “buy-and-bill” method, and payers’ interest in bundled payments—a team approach is more vital than ever.

“I don’t care how big and strong your hospital, network, or practice is; no one can figure all of this out on their own,” he said. “You have to be associated with other like-minded groups and practices to learn as a team.”

The patient should be at the center of a value-based model, and individuals in every aspect of the practice (ie, physicians, spiritual services, financial counselors, and support groups) should be given the opportunity to interact with patients.

“Ten or 15 years ago, the physician was in many ways the center of the practice, but that’s not how things work now,” said Dr Page.

An effective team approach to cancer care utilizes everyone, including nurse practitioners, physician assistants, medical assistants, triage nurses, and pharmacists, to the top of his or her training, he said.

Dr Page urges a team approach to documentation, because physicians typically spend 1 to 2 hours every night on catch-up work; his practice successfully implemented a “virtual scribe” system to address this issue, thereby significantly reducing physicians’ workload. He also recommends hiring an additional medical assistant and optimizing the use of back office coders.

Transforming Your Practice

The market is rapidly trending toward value-based, advanced, alternative payment models, but the majority of oncology groups are still practicing in a fee-for-service environment that provides decentralized, fragmented patient care with limited support.

According to Dr Page, becoming an Oncology Medical Home can bring a practice into the modern era, by improving access to healthcare, increasing patient satisfaction and the efficient delivery of care, and reducing costs. He says that much of the value gained from the Oncology Medical Home infrastructure comes through the refinement of day-to-day patient care processes, which translates to superior outcomes.

He also urges clinicians to more effectively use the support services that are already established in their institution (psychotherapy, dietitians, social workers, pain management specialists), because these directly mitigate the risks from “peripheral” problems that often increase costs and reduce positive outcomes.

In a fee-for-service environment, physicians frequently address problems in the examination room without using a team approach, whereas an Oncology Medical Home environment utilizes dedicated triage nurses and nurse navigators, centralized phone lines, and scripted triage pathways (based on the prevention of hospital and emergency department visits), with expanded hours and dedicated triage clinic time.

A fee-for-service system lacks standardization in the delivery of chemotherapy. Conversely, an Oncology Medical Home system uses a standardized approach, with a focus on treatment pathways. The clinical focus in a fee-for-service environment is often on treating the disease, rather than on healing lives, whereas an Oncology Medical Home environment offers patient support tools, such as patient portals, clinical trials support, psychosocial distress evaluations, and survivorship clinics.

The cultural move from a traditional oncology practice to an Oncology Medical Home model requires educating everyone, from the physicians and the board to the patients and the administrative staff, he said. It also requires aggressively pursuing relationships with foundations and implementing transitional care (ie, immediate follow-up postdischarge and improvements in chronic care management).

But according to Dr Page, making the transition from a fee-for-service to an Oncology Medical Home environment can take an oncology practice from simply delivering treatments to healing lives and improving value.