May 2017 Edition Vol.11, Issue 5

Oncology Care Model: Early Learnings

By Christina Bennett, MS

Two practice administrators from groups participating in the Oncology Care Model (OCM) initiative shared their experiences on the first year of this program during a panel session at the 2017 Community Oncology Conference, held April 27-28 in National Harbor, MD.
“There are a lot of things that are great about this program, but there’s also a lot that we’ve had to work through to make it functional and sustainable for our practice,” said panelist Anne Marie Rainey, MSN, RN, CHC, compliance and quality control officer at Clearview Cancer Institute.

OCM is a five-year pilot project, running July 1, 2016, through June 30, 2021, and aims to reform fee-for-service reimbursement with value-based payments.

When asked whether physicians and practice staff understand OCM, Rainey said she has seen an obvious “disconnect.” Some people have “really bought into” OCM and “see the importance” while others see it as “just one more thing to add on.”

“That’s something we’ve really had to work through, and I’d say that in the last two to three months, we’ve really seen an increase in understanding,” she said.

The other panelist, Alti Rahman, MHA, MBA, practice administrator at Oncology Consultants, told the audience that his practice sought to create an understanding of why OCM was important “not just for a practice but also for community oncology in general.”

Although only 190 oncology practices are participating in OCM, all practices are shifting toward value-based care. With the Medicare Access and CHIP Reauthorization Act (MACRA) reporting starting this year, it requires physicians to choose one of two payment tracks: either the Merit-based Incentive Payment System (MIPS) or participation in an alternative payment model.

OCM is an alternative payment model. Under MACRA, physician reimbursement for Medicare beneficiaries will be affected starting 2019 based on 2017 quality measures.


Initial Challenges

When asked about challenges to implementing OCM, Rainey cited workflow changes and documentation.

“People don’t like change,” she said. “They’re very comfortable with how they were carrying out their everyday duties. Also, it seemed like OCM was just ‘adding paperwork’ or ‘clicks’ to the delivery of care.

The challenge that stood out to Rahman was the extra resources needed for reporting. Because data have to be extracted from the electronic medical record to fulfill certain aspects of reporting, the practice had to compare the cost of manual extraction with automated extraction, which required additional resources.

Rahman and Rainey both expressed a similar struggle with providing estimated cost of care to patients.

Providers really have to sit down and explain to the patient what cost of care actually includes, Rahman said. Otherwise, patients may be under the impression that the cost includes everything “inside the walls of our practice and outside the walls of the practice.”

When planning the budget for OCM, Rahman said that hiring new staff to execute OCM was “more of a clear-cut budget item,” but the difficulty was that existing resources would also be used. Determination of how much of existing resources to allocate toward OCM was a challenge.

Similarly, Rainey said that it’s been hard to sit down with the budget and say how much time an employee is spending on OCM.

“That’s something that we really want to quantify,” she said.

As for the technology involved in patient care, Rahman said it definitely needs some improvement in terms of creating a more unified method to track all the information; also there needs to be better interoperability between systems.

Rainey said that lack of interoperability has been a barrier for her practice.


Positive Outcomes

Panelists also noted several positive outcomes of OCM, one being better communication within the practice.

Rainey said they communicate more with their patients and now document certain items that historically they had not. One item in particular was advanced care directives.

They found that only about 1.5 percent of their patients had a Do Not Resuscitate (DNR) status in the structured field of the electronic medical record. Now, about 75 percent of Medicare patients at the practice have DNRs consistently documented.

“It’s really opened the door for us to have to ask patients about something that maybe is uncomfortable for the staff member, [and] it’s maybe uncomfortable for the patient to be asked that,” Rainey said.

As for patient benefit, Rainey said patients like seeing additional educational information about the prescribed drug, knowing the cost estimate, and receiving information printed out.

Rahman said that the beneficiary notification letter can be dense, so when informing patients about implementing OCM, practices should supplement the letter with an “easier” and “simpler” explanation.


First Feedback Round

At the end of March, practices received their first performance feedback reports for patients with 6-month episode cycles.

Rainey described receiving a feedback report as “a little bit overwhelming” but noted that after reading through the results, they were able to identify areas for improvement, such as high numbers of evaluation and management (E&M) visits and hospital and emergency room (ER) admissions.

They reviewed hospital and ER admissions and went patient by patient to determine where the communication “broke down” and why the patient went to the ER.

“We did find that in several instances it was because our nurses said, ‘well, go on and go,’” she said. “That’s a behavior that we want to correct.”

The practice also added triage pathways for nausea, vomiting, and diarrhea and plan to roll out a couple more pathways soon.

“We were glad to see the data were released and the depth and how much information was released. It was certainly a positive thing,” Rahman said regarding the feedback report. “Of course, then the challenge came of getting meaningful information out of it.”

Rahman explained that for patients who sought emergency care outside of the practice, the report provided a “high level view” of admitting diagnosis and cost associated.

Both panelists mentioned possibly engaging with data analytics companies to further explore the data and its meaning.


Patient Engagement

As a result of OCM, Rahman’s practice, which already had weekend hours, extended their after-hours on weekdays and incorporated additional services. In contrast, Rainey said they have not adjusted practice hours, which are 7 am to 6 pm, Monday through Friday.

Rahman pointed out that their practice had to adequately communicate their extended hours to patients and encourage patients to call the practice before going to the ER because “patients can be so used to accessing other care centers.”

Rainey’s practice is kicking off a Call Us First campaign to encourage patients to call the practice before going to the ER.


Words of Advice

Regardless of whether a practice is participating in the OCM or not, the changes that are currently taking place will eventually influence all practices. These examples of real-world experiences may be able to provide some of the groundwork for practices to start thinking of where they need to go next so that they are in alignment with payment reform policies currently under consideration. Involving key stakeholders early in the process, and communicating openly and frequently can only help practices stay focused as evidenced by the presenters here.

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