Implementing the Oncology Care Model: Lessons Learned

Meg Barbor, MPH

July 2017, Vol 7, No 7 - Oncology Care Model

Washington, DC–The Oncology Care Model (OCM) is a physician-led specialty care model that is aimed at providing higher quality, more highly coordinated oncology care at the same or lower cost to Medicare beneficiaries. At the 2017 Association of Community Cancer Centers meeting, 2 experts shared their experience with transforming their practice into an OCM.

The OCM requires that a clinician with real-time access to certified electronic medical records is available to patients 24 hours a day, 7 days a week. Patients must also have access to support services, and treatment plans must comply with evidence-based national guidelines. Physicians are required to utilize the 13-point Institute of Medicine (IOM) Cancer Care Management Plan, and because the OCM operates under a value-based physician reimbursement model, physicians must adopt the 14 new OCM oncology quality measures.

OCM treatment plans must be personalized and tailored to meet the needs of the patient, and the IOM care plan helps providers to do that.

“The IOM care plan is a change in practice for some physicians,” said Nikolas Buescher, MHS, Executive Director of Cancer Services, Penn Medicine/Lancaster General Hospital, PA. “Medicare wants to make sure we’re having these conversations with patients, documenting them, sharing them with the care team, and closing the loop with referring physicians that need to know this information,” he explained.

Integrating the quality measures has been a challenge for many practices. The OCM requires reporting on measures that many providers have never calculated, and all beneficiary-level measures must be reported for at least 97% of patients.

“This goes above and beyond what a lot of us have done for other quality improvement projects,” said Mr Buescher.

The Physician Perspective

Elizabeth Horenkamp, MD, Managing Physician, Hematology/Oncology Medical Specialists, a 9-physician group within Penn Medicine/Lancaster General Health, shared the physician perspective on implementing these OCM requirements and how it is faring with their OCM’s quality improvement measures.

“We took an incredibly long list of requirements and boiled them down to 3 big topics that the OCM project was asking us to consider—improving patient engagement, documentation of evidence-based standards, and delivery of care in the lowest-cost setting,” said Dr Horenkamp.

Approaching the OCM this way nicely compartmentalizes the project goals, and presenting it in this fashion can make it easier to “sell” to physicians, she said. The next big issue was implementation.

“Luckily our institution has been requiring us to collect quality data that has been tied to physician compensation since 2010, which has been helpful moving forward,” said Dr Horenkamp. “My physicians have learned the hard way that collecting data—and not just as a random sample—has been important,” she added.

The practice’s OCM project team consists of individuals from a wide range of disciplines, and the work is dispersed consistently among the group. The supportive care team took on advance care planning, physicians are involved with designing proposed treatment care plans, and nursing tackled anticancer therapy education.

“If we continue to only load this on physicians, nurses, or medical assistants, any one group is going to fold,” she said. “Nursing did a huge heavy lift with changing the way we do chemotherapy education. As per patient request, we now do anticancer therapy patient education, because not everyone is getting chemotherapy,” she added.

In addition, the practice implements nutrition, distress, and depression screening; identifies at least 3 patients daily who have not yet had advance care planning discussions; and sets reminders for survivorship care visits.

Preset phrases with kind but unambiguous language are now used in discussing the cancer care plan with patients. Patients do not always understand whether their cancer can be cured; therefore, providers use 1 of 4 preplanned statements to communicate prognosis, such as, “Your cancer cannot be cured with treatments we have available today; however, it may be controlled for months or years.”

In addition, patients often do not know how long they will have to stay in the hospital, or what side effects they can expect from treatment. Furthermore, many patients do not understand the logistics of their chemotherapy treatment, have not had conversations about surgery or radiation, and do not know who to turn to if they encounter a problem during therapy. Dr Horenkamp and her team now discuss these issues openly with patients.

Quality Improvement

The OCM is a 5-year project that is broken down into 6-month performance periods. Mr Buescher recommends viewing the Centers for Medicare & Medicaid Services’ data reports as confirmatory rather than informative, because institutions should be collecting and managing their own data.

“We want to make sure our best ideas don’t die in the board room, but are actually implemented in the exam room,” added Mr Buescher.

Care teams are provided with weekly reports that document all active OCM episodes on their schedule at that time, and daily huddles are conducted to discuss quality measures.

“We’re focused on generating data rapidly and implementing ideas as quickly as we can so that we can report back in a day or week on how it works,” he said. “If it does work, we want to run that information on to the next care team.”

Teams are able to see their performance compared with the rest of the group, allowing them to set their priorities moving forward.

“For the first time, we’re giving our physicians and care teams information on what they need to do tomorrow to get the highest possible quality score,” he said.

The decision to implement the OCM was not about money, but rather about doing the right thing for their patients, said Mr Buescher.

“One of the reasons we decided to go with the OCM is that it was confirmatory of a lot of strategic planning we’ve been doing for the past 5 years. We knew we wanted to go deeper into shared decision-­making and advance care planning,” he said.

“The work is never done, and it will require a lot of fine tuning, but in our view, survival 10 years from now depends on seeing the OCM not as one more thing to do, but rather as the one thing to do,” Mr Buescher concluded.