First Level III Oncology Medical Home Wastes Fewer Resources

Chicago, IL—Offering superior quality of care at lower cost, Consultants in Medical Oncology and Hematology (CMOH) is the first oncology practice in the nation to achieve Level III recognition by the National Committee for Quality Assurance.

“The oncology-patient centered, medical-home model has standardized approaches to care from assessment to patient navigation and disease management,” said John D. Sprandio, MD, oncologist and owner of CMOH.

“Four terms to remember in achieving accountable cancer care are patient needs, quality, value, and demonstration of results,” he said at the 2011 Cancer Center Business Summit. “That is what healthcare reform is all about.”

Dr Sprandio and his colleagues at CMOH began transforming their practice in 2004 in preparation for a change in payment method that would reimburse the practice based on the quality of care provided.

As the practice was transformed to electronic medical records, customized software was being developed to better suit practice, patient needs, and data collection. These customized software applications were also designed to support comprehensive processes of care that were required for the Level III, patient-centered, medical home recognition, Dr Sprandio explained.

Care-Coordinated Model Encourages Clinical Integration

The care-coordinated model was developed to “promote a value-based agenda that facilitates physician accountability and encourages clinical integration among like-minded medical oncology practices,” he said. “It enhances communication and coordination with primary care. In the past 4 months, it has promoted collaboration with payers. It does all this while focusing on patient needs and evidence-based care.”

The primary care team addresses all nononcologic issues. “We take responsibility for the coordination of all oncologic-related services, from the time of diagnosis through the survivorship stage of care or to the time of death,” said Dr Sprandio.

Patient engagement is the focus according to Dr Sprandio, especially the encouragement of patients to be proactive about reporting symptoms, as early treatment of symptoms often results in fewer hospitalizations.

Standardized Care
The model promotes collaboration between the caregiving team, adherence to evidence-based guidelines, prevention of complications, and increasing access to care, “all in a standardized way.”

“Everything is standardized…patient assessment, collection of data, documentation, patient navigation…. Telephone triage has been a big plus in directing patients away from the ER [emergency room] and more toward self-management,” he said. Potentially avoidable complications have been defined, measured, and reduced in number. “We’re also big proponents of integrated palliative care from the time of diagnosis and allowing physicians to track it.”

Triage Call Service
The nurse-triage call service has taken 3900 calls during the past year; of these calls:

  • 75% of patients’ symptoms were managed at home
  • 4.3% of patients who went through the phone triage were referred to the emergency department (5.8% overall since 2006)
  • 5.5% were seen the same day
  • 4.5% were seen the next day.

“We encourage them to call early. If they think they might have a problem at 8:00 in the morning, we encourage them to call by 8:15. Calling us at 4:15 may result in an unnecessary ER evaluation,” said Dr Sprandio.

The impact on emergency department utilization has been significant, Dr Sprandio noted. The number of emergency department visits per chemotherapy-receiving patient has been reduced from 2.6 in 2004 to 0.91 in 2010. The number of hospital admissions per chemotherapyreceiving patient was 0.6 in 2010. Documentation turnaround time has been reduced from 28 days to less than 1 day.

Patient outcomes have not been affected by the reductions in the number of emergency department visits and hospitalizations, Dr Sprandio observed.

End-of-life care offered by the practice has resulted in an increase in the average hospice length of stay from 26 days in 2009 to 32 days in 2010. The end-of-life discussions have resulted in less use of chemotherapy by the practice, and the number of outpatient chemo - therapy visits has declined by 12%.

The oncology medical home model, coupled with a pathways program, has led to:

  • A 43% reduction in hospitalizations
  • A 65% reduction in emergency department evaluations
  • An estimated savings between 6.6% and 12.7% of the total cost of cancer care.

“If you plug in our numbers, it was higher than 13%,” Dr Sprandio said.

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