2015 Forecast Series—Bruce Gould, MD, Northwest Georgia Oncology Centers, President of Community Oncology Alliance (COA)
OBR: It seems like the information overload, in particular keeping up with new clinical data and information, is harder than ever. Meetings, presentations, CME, new drugs, new information outlets…How do you recommend your membership to "stay on top of it all” in 2015?
BG: There is a myriad of information available to medical oncologists to help further their education and improve their knowledge basis for the care of patients. How each physician utilizes that information is something that is very personal. I would say the majority of my colleagues like to use references that consolidate the disparate sources of information and condense and organize it into a format that is readily utilized. Examples of these sources of information include Up-To-Date, NCCN Guidelines, and ASCO and ASH Best of Meetings. In addition, expert opinions such as Blood's “How I Treat” are also very helpful. Having summaries of relevant clinical studies presented and interpreted by well-respected experts are invaluable sources of help for the busy medical oncologist.
OBR: How do you think oncologists are doing with implementation of EMRs? Do you anticipate many of them will have to pay penalties this year for not fulfilling meaningful use requirements?
BG: Based on the feedback I am hearing from many of my colleagues, most have been able to comply with Stage 1 (years 1 & 2) of meaningful use, and do not anticipate payment penalties in 2015. However, Stage 2 is a bit more problematic. The 2015 requirements mandate a full-year of reporting using the 2014 Edition Certified EHR Technology (CEHRT). While most EHR vendors have their 2014 CEHRT in production, I am hearing concerns that the new software is unstable and/or slow, which creates workflow issues for patients and providers. Because of this, many practices like mine have postponed implementation of the 2014 CEHRT and, therefore, will be subject to penalties for a problem beyond their control. In fact, Congresswoman Renee Ellmers has introduced legislation, H.R. 5481 the Flex-It Act, which would require only a 90-day reporting period in 2015 versus a full year.
OBR: Please update us on the sequester problem. Is it still changing treatment patterns? Is there hope for passage of H.R. 1416 to end the disproportionate cut to injectable cancer drug reimbursement?
BG: The Medicare sequester cut, especially to cancer drugs and other Part B therapies, is a real problem. It has forced practices to close facilities, especially in rural areas, sending more patients to hospitals for treatment, and even to sell the practice to the hospital. The irony is that the large community oncology practice in the district of Congresswoman Ellmers (the author of H.R. 1416, the bill to stop the sequester cut to cancer drugs) attributed the sequester as part of why the practice closed two treatment clinics and disbanded the practice. Given this is a new Congress, a new version of H.R. 1416 will have to be introduced early this year. COA is working with Congresswoman Ellmers and other members of Congress to stop this cut. It is a tough battle because the sequester impacts everything, including the national defense budget, and is wrapped up in politics. However, COA will once again lead the charge to get this harmful cut stopped and we will not give up.
OBR: How urgent is it that some sort of payment reform gets into place for community oncologists? What payment reform model does COA think works the best?
BG: Tomorrow may be too late. Although the pace has slowed somewhat, many practices are still considering becoming part of large hospital systems. COA supports payment reform that is focused on providing superior quality and service for patients, provides value for payors/employers, and rewards providers for their performance against regional or national benchmarks. The model should require a minimal number of meaningful measures specific to evidence-based guidelines, clinical quality, patient satisfaction, and cost initially for emergency room and hospital utilization. The model should not create undue administrative burdens for practices, and must offer additional payments based on performance that can sustain the viability of community oncology.
COA is encouraged by Congresswoman Cathy McMorris Rogers’ (R-WA) recently released discussion draft of the Cancer Care Payment Reform Act, which addresses many of the issues we feel are needed for meaningful payment reform (see attached summary).
NOTE: summary can be hyperlinked to http://blog.communityoncology.org/userfiles/76/Oncology_Payment_Reform_Legislative_OutlineF.pdf
OBR: Tell us about the COA Oncology Medical Home project, and especially how this model contributes to improving quality cancer care.
BG: The COA model has evolved a great deal since our initial Steering Committee meeting in February 2012. Ultimately, the proof of success will be in the data. The primary tenets of the Oncology Medical Home (OMH) include adherence to evidence-based treatment guidelines, structured triage, patient engagement/education, expanded access (same day appointments), comprehensive coordination of care, quality improvement, and patient satisfaction. Following these has allowed our practice to participate in three innovative payment pilots: the UnitedHealthcare Episode of Care pilot, Dr. Barbara McAneny’s CMMI Come Home grant project, and most recently an Aetna OMH pilot.
The United Episode of Care results have been well documented regarding outcomes and total cost savings and I am confident we will see similar successes in our other two pilots once all of the data are analyzed and reported. I am also certain that had our practice not implemented the basic structure and processes of the OMH that our results would be different. It is also very exciting that COA has worked closely with the Commission on Cancer to develop an OMH accreditation program that the seven COME Home practices and three others will be piloting the first quarter of this year.
OBR: A big day for physicians this year is October 1, 2015. Is there anything you want to tell oncologists to prepare them for ICD-10 implementation?
BG: Aside from wishing for another delay in its implementation, I would encourage the physician leadership in each practice to begin working closely with their management and reimbursement team to begin the education and training process for providers and staff now versus later. Additionally, many EMR vendors have built into their software the ability to “crosstalk” between ICD 9 and ICD 10, which should make the transition go smoother.