Impact of a G-CSF Policy to Reduce Low-Value Care on Guideline Adherence and Mortality

Orji, Chinelo C.; Brown, Carolyn M.; Hoverman, J. Russell; Richards, Katherine; Garey, Jody S.

doi:10.1200/op.20.01045

Cited by 4 publications

(6 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…22,23 Decision support and practice-implemented policy interventions have also shown effectiveness in changing the use of supportive care medications. 24,25…”

Section: Discussionmentioning

confidence: 99%

Impact of the Oncology Care Model on Use of Supportive Care Medications During Cancer Treatment

Brooks

Landrum

Kapadia

et al. 2022

JCO

View full text Add to dashboard Cite

PURPOSE The Oncology Care Model (OCM) is an episode-based alternative payment model for cancer care that seeks to reduce Medicare spending while maintaining care quality. We evaluated the impact of OCM on appropriate use of supportive care medications during cancer treatment. METHODS We evaluated chemotherapy episodes assigned to OCM (n = 201) and comparison practices (n = 534) using Medicare claims (2013-2019). We assessed denosumab use for beneficiaries with bone metastases from breast, lung, or prostate cancer; prophylactic WBC growth factor use for beneficiaries receiving chemotherapy for breast, lung, or colorectal cancer; and prophylactic use of neurokinin-1 (NK1) antagonists and long-acting serotonin antagonists for beneficiaries receiving chemotherapy for any cancer type. Analyses used a difference-in-difference approach. RESULTS After its launch in 2016, OCM led to a relative reduction in the use of denosumab for beneficiaries with bone metastases receiving bone-modifying medications (eg, 5.0 percentage point relative reduction in breast cancer episodes [90% CI, –7.1 to –2.8]). There was no OCM impact on use of prophylactic WBC growth factors during chemotherapy with high or low risk for febrile neutropenia. Among beneficiaries receiving chemotherapy with intermediate febrile neutropenia risk, OCM led to a 7.6 percentage point reduction in the use of prophylactic WBC growth factors during breast cancer episodes (90% CI, –12.6 to –2.7); there was no OCM impact in lung or colorectal cancer episodes. Among beneficiaries receiving chemotherapy with high or moderate emetic risk, OCM led to reductions in the prophylactic use of NK1 antagonists and long-acting serotonin antagonists (eg, 6.0 percentage point reduction in the use of NK1 antagonists during high emetic risk chemotherapy [90% CI, –9.0 to –3.1]). CONCLUSION OCM led to the reduced use of some high-cost supportive care medications, suggesting more value-conscious care.

show abstract

“…22,23 Decision support and practice-implemented policy interventions have also shown effectiveness in changing the use of supportive care medications. 24,25…”

Section: Discussionmentioning

confidence: 99%

Impact of the Oncology Care Model on Use of Supportive Care Medications During Cancer Treatment

Brooks

Landrum

Kapadia

et al. 2022

JCO

View full text Add to dashboard Cite

show abstract

“…While prior studies used data prior to 2011 and reported underutilization of G-CSF among patients with cancer receiving high-FN risk regimens, 8,29 our study showed a gradual increase in G-CSF use among patients receiving high-FN risk regimens in the past 5 years in both populations. population may be related to implementing practice improvement policy initiatives 12 and decision support tools 14,30 aimed to reduce overutilization and inefficient practices in such patients. Despite observed reductions, the appropriateness of continued G-CSF use among patients with intermediate or low risk should be determined to promote efficient use of G-CSFs.…”

Section: Discussionmentioning

confidence: 99%

“…According to NCCN guidelines, 3 the appropriateness of G-CSF use among patients receiving intermediate– or low–FN risk regimens is dependent on other risk factors and clinical judgment. Drivers of the observed decreases in G-CSF use among patients receiving intermediate– or low–FN risk regimens in the commercially insured population may be related to implementing practice improvement policy initiatives 12 and decision support tools 14 , 30 aimed to reduce overutilization and inefficient practices in such patients. Despite observed reductions, the appropriateness of continued G-CSF use among patients with intermediate or low risk should be determined to promote efficient use of G-CSFs.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 10 , 11 These suboptimal prescribing patterns can have serious consequences, such as underutilization leading to lengthy inpatient stays associated with FN and overutilization causing inefficiency and waste. Quality improvement interventions implemented by certain institutions 12 , 13 and payers 14 have shown positive outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in Use of Granulocyte Colony-Stimulating Factor Following Introduction of Biosimilars Among Adults With Cancer and Commercial or Medicare Insurance From 2014 to 2019

et al. 2021

View full text Add to dashboard Cite

Key Points Question What were the utilization trends associated with granulocyte colony-stimulating factors for primary prophylaxis of febrile neutropenia (FN) among patients with cancer receiving myelosuppressive chemotherapy from 2014 to 2019? Findings This cross-sectional study of 119 129 chemotherapy courses found that among commercially and federally insured populations, use of granulocyte colony-stimulating factors increased among patients receiving high–FN risk regimens, from 75% to 83% for the commercially insured population and from 75% to 86% for the Medicare population. Meaning This study found that there were increases in the use of granulocyte colony-stimulating factors among patients with high FN risk, but 14% to 17% of patients with high FN risk still did not receive preventive treatment.

show abstract

“…One example is omitting a granulocyte stimulating factor for low-risk chemotherapy regimens, 17 or with metastatic cancer, where dose reduction is a reasonable alternative. 18 Another example of omitting an unproven but commonly used drug is that of maintenance bevacizumab in metastatic colon cancer. 19 A final strategy to reduce drug costs is dose rounding.…”

Section: Choosing High-value Drugsmentioning

confidence: 99%

Secret Sauce—How Diverse Practices Succeed in Centers for Medicare & Medicaid Services Oncology Care Model

Kline

Blau

Buescher

et al. 2021

JCO Oncology Practice

Self Cite

View full text Add to dashboard Cite

PURPOSE: CMS' Oncology Care Model (OCM) is an episode-based alternative payment model designed to incent high-value care through the use of monthly payments for enhanced services and performance-based payments on the basis of decreases in spending compared with risk-adjusted historical benchmarks. Transitioning from a fee-for-service model to a value-based, alternative payment model in oncology can be difficult; some practices will perform better than others. We present detailed experiences of four successful OCM practices, each operating under diverse business models and in different geographic areas. METHODS: Practices that achieved success in OCM, on the basis of financial metrics, describe pathways to success. The practices represent distinct business models: a medium-sized community oncology practice, a large statewide community oncology practice, a hospital-affiliated practice, and a large academic medical center. RESULTS: Practices describe effective changes in practice culture such as new administrative flexibilities, physician champions, improved communication, changes in physician compensation, and increased physician-level transparency. New or improved clinical services include acute care clinics, care coordination, phone triage, end-of-life care programs, and adoption of treatment pathways that identify high-value drug use, including better use of supportive care drugs. CONCLUSION: There is no one thing that will ensure success in OCM. Success requires whole practice transformation, encompassing both administrative and clinical changes. Communication between administrative and clinical teams is vital, along with improved data sharing and transparency. Clinical support services must expand to manage problems and symptoms in a timely way to prevent costly emergency department visits and hospitalizations, while constant attention must be paid to making high-value therapeutic choices in both oncolytic and supportive drug categories.

show abstract

Impact of a G-CSF Policy to Reduce Low-Value Care on Guideline Adherence and Mortality

Cited by 4 publications

References 17 publications

Impact of the Oncology Care Model on Use of Supportive Care Medications During Cancer Treatment

Impact of the Oncology Care Model on Use of Supportive Care Medications During Cancer Treatment

Trends in Use of Granulocyte Colony-Stimulating Factor Following Introduction of Biosimilars Among Adults With Cancer and Commercial or Medicare Insurance From 2014 to 2019

Secret Sauce—How Diverse Practices Succeed in Centers for Medicare & Medicaid Services Oncology Care Model

Contact Info

Product

Resources

About