The Ins and Outs of Working with the Oncology Care Model
Orlando, FL—The cost of cancer care is rising quickly, and, as a result, oncology is moving away from the fee-for-service payment model toward the Oncology Care Model (OCM).
Under the OCM, physician practices enter into payment arrangements that include financial and performance accountability for episodes of care related to chemotherapy administration. The OCM was designed to improve quality by using quality metrics and measures to assess patient care.
At the 2017 Quality Care Symposium, Blase N. Polite, MD, MPP, Executive Medical Director for Cancer Accountable Care, University of Chicago Medicine, IL, discussed the OCM implementation experience at his institution. Certain planning and implementation strategies can be helpful in making the transition, he said, but major barriers do exist, particularly when attempting to “herd angry, overworked, and EMR–burned-out cats,” Dr Polite suggested.
A medical center the size of University of Chicago Medicine would receive approximately $1.5 million to $2 million from the federal government to implement the OCM, and the first big decision is deciding where that money should go in terms of care coordination, he said. “There are certain guiding principles I try to lay down to faculty when I talk about these changes,” Dr Polite said.
First, workflow changes—designed with busy clinicians and clinics in mind—should enable better and more consistent care of patients. Different groups in the system should share the workflow burden, allowing individuals to work at the upper end of their training. Results from the workflow should allow for easy extraction of data for real-time quality reporting and analytic needs, thereby placing an institution at the upper tier of compliance with payer requirements.
“But these changes are not written on stone tablets, and refinements are anticipated and expected,” noted Dr Polite. “The understanding is that we’re going to make mistakes as we try to refine this process going forward.”
When implementing the OCM, risk adjustment becomes an integral component of a provider’s responsibilities. Coding selected noncancer comorbidities becomes absolutely critical when moving forward with Alternative Payment Models, because the price differential could be upward of $10,000 for a patient with 3 comorbidities compared with a patient without comorbidities, said Dr Polite.
Where Can Savings Be Made?
Chemotherapy and inpatient costs account for the bulk of spending during the patient’s first 6 months of chemotherapy, so focus on these 2 areas if you want to be successful in this model, urged Dr Polite.
Medicare can provide granular data so that institutions can actually see their costs per episode, and average episode costs can be divided by different cancer program types so that vulnerabilities are evident.
Dr Polite advises keeping a close eye on quality metrics, and encouraging transparency so that changes can be made in real time if specific programs or providers are not capturing data appropriately. The University of Chicago began tracking time from discharge to outpatient appointment, and Dr Polite said he did not believe the numbers. From the time a patient left the hospital to the median day the patient got a follow-up appointment in oncology was 19 days: the national standard should be less than 7 days.
“We’re putting a lot of time and resources into changing this, which we believe will also help with unplanned readmissions,” he noted.
Next, examine the emergency department data and determine the reasons for admissions, and look at drug data to determine which drugs are most common by episode. “Start looking at where your liabilities and your opportunities are,” Dr Polite advised.
To identify high-risk patients, the University of Chicago piloted and implemented a supportive oncology screening tool, comprising 10 validated assessments that are used to determine a patient’s needs for supportive care services. The screening tool showed that 38% of visits resulted in a positive screening, but only 27% of positive screenings had an associated action documented.
“Providers need to actually use the information,” said Dr Polite. “In the real world you can build things, make them look nice, and have consensus, but it’s just another thing you have to go through when seeing a patient, and if it’s left as a passive action, people will follow the path of least resistance,” he added.
Back to the Big Question: Where Should the Money Go?
Enhance the patient experience, said Dr Polite. Invest in care coordination and navigation, provide staff for after-hours urgent care to avoid emergency department visits, and ensure that pharmacists are managing high-risk patients with low health literacy who are taking complex drugs. In addition, staff outpatient case managers, social workers, and palliative care providers, and use system tools to ensure that referral loops are closed, advised Dr Polite.
“At the end of the day, money can’t get your staff to collect and act on the information provided to them. It has to be a cultural, institutional, and functional change,” he said. “Our team meets on a regular basis to implement the OCM, and it includes everyone in the hospital, which has been a wonderful part of coordination toward a common goal,” said Dr Polite.