Practice Transformation: Early Impact of the Oncology Care Model on Hospital Admissions

Abstract

Purpose: The purpose of the Oncology Care Model (OCM) is to improve quality and reduce cost through practice transformation. A foundational tenant is to reduce avoidable emergency room (ER) visits and hospitalizations. In anticipation of being an OCM participant, we instituted a multidimensional campaign designed to meet these objectives. Methods: Prior actions included establishment of phone triage unit, after-hours and weekend calls, and institution of weekend urgent care. Results: On the basis of data from the Chronic Condition Warehouse, as provided by the Centers for Medicare and Medicaid Services, we were successful at reducing the acute care admissions rate by 16%. During the baseline period extending from Jan 2016-Mar 2016, the hospital admission rate was 27 per patient, per quarter, at an average cost per admission event of $11,122, translating to an inpatient cost per patient, per quarter, of $3,003. In the year one reporting period of July 2016-July 2017, the hospital admission rate declined to 22.6 per patient, per quarter, at an average cost per admission event of $11,106, translating to an inpatient cost per patient, per quarter, of $2,505. OCM patient survey scores improved. In addition, at Oncology Hematology Care, we achieved improved results compared with the risk-adjusted national averages for the following measures: readmissions (4.9 v 5.6 per 100 patients, respectively), ER use (17 v 18.6 per 100 patients, respectively), and observation stays (2.7 v 3.6 per 100 patients, respectively). Conclusion: By implementing a cost-efficient, reproducible, and scalable campaign targeting ER avoidance and hospitalizations, we were able to decrease hospital admissions. Reported Medicare savings amounted to nearly $798,000 in inpatient cost per quarter over 1,600 patients.

Evaluating the Impact of Oncology Care Model Reporting Requirements on Biomarker Testing and Treatment

“…1 Currently, there are limited published data evaluating the impact of the OCM on downstream outcomes of interest. 10 - 12 This is one of the first comparative studies to examine the specific association of OCM reporting requirements with downstream quality of care, offering additional insights into the differences between OCM and non-OCM practices.…”

The Centers for Medicare & Medicaid Services Oncology Care Model Halfway Through: Perspectives from Diverse Participants

“…Because of OCM, our patients receive not only extensive instruction about their treatment and potential complications but also a plan including clinical stage, risks, and prognosis. These initiatives have generally been accepted across all 16 practices, and in the first performance period, 9 of 16 practices reduced their hospitalizations, and in the second performance period, 11 of 16 did (8,9).…”

The impact of provider payment reforms and associated care delivery models on cost and quality in cancer care: A systematic literature review

“…The SLR identified a cancer care delivery reform, implemented as a five-year model by CMS to provide coordinated, high-quality care for oncology practices using alternative payment arrangements with CMS; this included financial and clinical performance accountability for episodes of care. Mendenhall et.al [41] used risk-adjusted national averages of all practices providing cancer care in the same patient risk quartile as the comparator cohort to evaluate the impact of a multifaceted care delivery approach targeting unnecessary ED and hospital admissions. The strategy included increased care coordination, adopting standardized pathways, urgent care tactics, and patient education.…”