Oncology Care Model Saved Medicare $3 Million in 1 Year

Roxanne Nelson, BSN, RN

October 01, 2018

The Oncology Care Model (OCM) was rolled out in July 2016 by the Centers for Medicare & Medicaid Services (CMS), with the goal of providing higher-quality care while at the same time lowering cost.

New findings show that at one large community practice, implementing an OCM saved Medicare $3 million over the course of 1 year.

"Implementing OCM resulted in decreased hospital admissions without significantly increasing ER visits or observation stays," said lead study author Molly Mendenhall, BSN, RN, from Oncology Hematology Care, Cincinnati, Ohio. "Admissions were decreased 16% in the first year of OCM, resulting in savings of $3.129 million for CMS in 1 year."

Mendenhall presented her findings at the American Society of Clinical Oncology (ASCO) Quality Care Symposium (QCS).

"We believe in quality and value-based programs, and we plan on staying in the OCM program," she told Medscape Medical News.

She pointed out that it was too soon to conduct an economic assessment to see how participation in the OCM may have benefited their practice by cutting costs. "Early data suggest that we may break even," Mendenhall said. "This was a large endeavor, and we are looking at deep diving into those investments."

But importantly, she emphasized, patient care was improved. "We are seeing an increase in patient satisfaction, as patient satisfaction scores have gone up."

Oncology Hematology Care in Cincinnati is an independent community-based oncology practice comprising 23 medical oncologists, 10 radiation oncologists, three gynecologic oncologists, and 20 advanced practice providers (APP). Care is delivered at 16 sites, and the practice serves five different health systems.

Participation in the OCM pays providers the standard fee-for-service reimbursement and an additional $160 per month per patient for enhanced care coordination. In addition, if requisite quality thresholds are met and aggregate payments fall below the target, OCM practices receive a performance-based payment.

Reduced Medicare Spending

In this study, Mendenhall and her colleagues assessed the impact of the OCM after the first year of implementation. The primary goal was to reduce avoidable emergency department (ED) visits and hospitalizations. Secondary goals were to assess the impact of OCM initiatives on observations stays and hospital readmissions. Another objective was to evaluate the savings to CMS resulting from OCM initiatives targeting hospital utilization.

Mendenhall explained that in anticipation of becoming an OCM participant, the Cincinnati practice instituted a multidimensional campaign designed to meet these objectives. A phone triage unit was initiated, and after-hours triage and a weekend urgent care clinic were established. In addition, follow-up calls were made to patients after they had received chemotherapy.

After participation began, the practice continued to initiate new measures. These included the following:

  • improved education provided by nurse navigators and APPs prior to the start of treatment (OCM Treatment Planning visit);

  • implementation of triage pathways (38 symptom and 27 follow-up pathways), which were a modified version of the COME HOME model;

  • proactive symptom follow-up calls to help circumvent emergent admissions;

  • an increase in APP staffing to provide blocked time slots for same-day patient visits without disrupting schedules; and

  • initiation of a Call Us Early – Call Us First campaign.

"We made the decision to use pathways as part of the evolution of our triage department," she explained. "Using pathways helped us streamline patient care and save us time and make immediate decisions."

They also incorporated verbal and/or written instructions at all patient touch points that emphasized that it was the patient's responsibility to call before going to the ED.

From July 2016 to June 2017, 1600 patients were seen per quarter. There were 22.6 admissions per 100 patients per quarter, down from 27 during the period of January 2016 to March 2016.

The inpatient cost per quarter was $2505.00, reduced from $3003.00.

On the basis of data from the Chronic Condition Warehouse, as provided by CMS, the practice was successful at reducing the acute care admissions rate by 16%.

Results Promising, Some Caveats

The discussant for this paper, Gabrielle Betty Rocque, MD, from the University of Alabama at Birmingham, noted that one of the important things to consider is the monumental number of steps that were taken to attain the changes that were observed. "They did a number of interventions that were rolled up into one practice transformation," she said.

The authors clearly met their primary goals and should be applauded, as they were able to do this across 16 sites, Rocque noted. "They had true practice change with a multidisciplinary team, and they engaged patients in their care, and this is very important in practice transformation," she said. "They were also able to benchmark against national practice."

However, there were also limitations, one being that this was a nonrandomized study, and it is difficult to quantify preventive admissions. "It is also important to note that implementation of changes began well before the OCM, and these changes do not occur quickly," she explained. "We often expect to see change and results very quickly, but that is not realistic, so we need to be able to understand the evolution of practice evolution — and when these events are occurring within a given practice."

One problem with multifaceted interventions is that it can be difficult to tell what is contributing to the changes that are observed. "It will be difficult for other practices to 'pick this off the shelf,' because it is not one intervention but many that led to the changes," Rocque pointed out.

Approached for comment on this study, Timothy Gilligan, MD, associate professor of medicine at the Cleveland Clinic Taussig Cancer Institute, Ohio, explained that the important message in this study is that "we talk about waste in healthcare, and it is becoming clearer and clearer that there are expenses that can be avoided.

"If we anticipate complications, we can help keep the patient out of the hospital," he said. "That is a great savings, as hospitals are every expensive."

The OCM model is taking a step in moving away from the fee-for-service model. "If we take better care of the patient, we can improve care and lower costs," said Gilligan. "We can design practice to better avoid ED visits."

For example, there are many situations in which the patient can be helped over the telephone and may not even need to come into the office, much less the ED. "But practices are not routinely reimbursed for that, so we need to change the models of care," he said.

He added that the current study is a pilot study with early 1-year data, so it remains to be seen what kind of cost savings the model will have for the practice itself.

No funding source was disclosed. Molly Mendenhall has disclosed no relevant financial relationships. Dr Rocque has disclosed relationships with Genentech/Roche, Pfizer, Carevive Systems, Medscape, and Pack Health. Dr Gilligan has disclosed a relationship with WellPoint.

American Society of Clinical Oncology (ASCO) Quality Care Symposium (QCS). Abstract 269, presented September 28, 2018.


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