The Oncology Care Model and Adherence to Oral Cancer Drugs: A Difference-in-Differences Analysis

Keating, Nancy L.; Brooks, Gabriel A.; Landrum, Mary Beth; Liu, Pang-Hsiang; Wolf, Robert; Riedel, Lauren; Kapadia, Nirav S.; Jhatakia, Shalini; Tripp, Amanda S.; Simon, Carol; Hsu, Van Doren; Kummet, Colleen; Hassol, Andrea

doi:10.1093/jnci/djac026

Cited by 7 publications

(10 citation statements)

References 31 publications

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“…BPCI-A recently excluded cardiac rehabilitation costs when calculating episode spending, lessening the disincentive against referring patients to this high-value service. Policy makers could similarly exclude high-value services (such as hormone therapy for low-risk breast or prostate cancers 5 ) from spending calculations in other episodes, especially if those services are also expensive.…”

Section: Market Distortionsmentioning

confidence: 99%

Medicare’s Bundled Payment Models—Progress and Pitfalls

Maddox

Shashikumar

Ryan

2022

JAMA

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Section: Market Distortionsmentioning

confidence: 99%

Medicare’s Bundled Payment Models—Progress and Pitfalls

Maddox

Shashikumar

Ryan

2022

JAMA

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“…Although the OCM neither achieved net cost savings nor demonstrated significant improvements in quality, the findings reported by Keating et al 5 are nonetheless important. The OCM was not associated with a decline in any critical quality measures, and this negative result is noteworthy.…”

mentioning

confidence: 99%

“…The data show that more practices earned a performancebased payment in period 4, which signals participants' capacity to reduce costs with time, experience, and performance feedback. 5 However, many questions remain. What were the OCM's spillover effects on non-Medicare patients?…”

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confidence: 99%

“…Drug costs are increasing steeply as a share of the total cost of cancer care. 5 Including drug spending in a bundle implies that oncologists have discretionary spending power in drug prescribing, which may not be true given the dynamic innovation in cancer treatment. Oncologists will substitute less costly regimens when there is clinical equipoise, such as with biosimilar agents and bonestrengthening agents, but for new agents there are often no viable alternatives.…”

mentioning

confidence: 99%

“…The Oncology Care First model must provide more timely feedback. Prospective rigorous evaluations such as the study reported by Keating et al 5 are also critical to maximize learning from these large-scale policy experiments.…”

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confidence: 99%

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Medicare Spending, Utilization, and Quality in the Oncology Care Model

Osarogiagbon

Mullangi

Schrag

2021

JAMA

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Health care costs are an issue of national importance. Health expenditures in the US are projected to reach $6.19 trillion by 2028, or 19.7% of gross domestic product, an estimated annual growth rate of 5.4% since 2019. 1 The growth rate for Medicare spending is projected to be even higher at 7.6% per year. 1 Cancer spending accounts for a significant proportion of these expenditures. Aging and population growth are projected to increase the costs of cancer care delivery from $183 billion in 2015 to an estimated $246 billion in 2030. 2 Although drug prices constitute the fastest-increasing proportion of cancer care costs, other significant drivers include suboptimal care coordination and inappropriate or duplicative services, exemplified by high rates of chemotherapy within 2 weeks of death; emergency department (ED) visits, hospitalization, and intensive care use within 1 month of death; and short durations of hospice enrollment. 3 The Centers for Medicare & Medicaid Services (CMS) designed the Oncology Care Model (OCM) to test whether an episode-based payment model could improve quality of care while containing cost. 4 The OCM represents the largest experiment to date with alternative payment models (APMs) in cancer care, with 201 voluntarily enrolled practices and 3200 oncologists. The program paired traditional fee-for-service payments with additional monthly payments of $160 per patient to practices for providing enhanced oncology services such as enhanced physician access, and also offered performance-based incentive payments. Although the OCM offered practices a choice between 1-sided (profit sharing only) and 2-sided (profit and loss sharing) risk arrangements, all practices chose the 1-sided risk option.CMS contracted independent researchers to formally evaluate the OCM to use this experience to inform future payment reform experiments. In this issue of JAMA, Keating et al 5 report these long-awaited results. The authors present a difference-in-differences analysis that compared care in 201 OCM-participating practices and 534 propensity-matched non-OCM practices. Relative to the baseline period (January 2014 through June 2015), both OCM and comparison practices increased total episode payments during the first 3 years of the

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Adoption of Innovative Therapies Across Oncology Practices—Evidence From Immunotherapy

et al. 2023

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ImportanceImmunotherapies reflect an important breakthrough in cancer treatment, substantially improving outcomes for patients with a variety of cancer types, yet little is known about which practices have adopted this novel therapy or the pace of adoption.ObjectiveTo assess adoption of immunotherapies across US oncology practices and examine variation in adoption by practice type.Design, Setting, and ParticipantsThis cohort study used data from Medicare fee-for-service beneficiaries undergoing 6-month chemotherapy episodes between 2010 and 2017. Data were analyzed January 19, 2021, to September 28, 2022, for patients with cancer types for which immunotherapy was approved by the US Food and Drug Administration (FDA) during the study period: melanoma, kidney cancer, lung cancer, and head and neck cancer.ExposuresOncology practice location (rural vs urban), affiliation type (academic system, nonacademic system, independent), and size (1 to 5 physicians vs 6 or more physicians).Main Outcomes and MeasuresThe primary outcome was whether a practice adopted immunotherapy. Adoption rates for each practice type were estimated using multivariate linear models that adjusted for patient characteristics (age, sex, race and ethnicity, cancer type, Charlson Comorbidity Index, and median household income).ResultsData included 71 659 episodes at 1732 oncology practices. Of these, 264 practices (15%) were rural, 900 (52%) were independent, and 492 (28%) had 1 to 5 physicians. Most practices adopted immunotherapy within 2 years of FDA approval, but there was substantial variation in adoption rates across practice types. After FDA approval, adoption of immunotherapy was 11 (95% CI, −16 to −6) percentage points lower at rural practices than urban practices and 27 (95% CI, −32 to −22) percentage points lower at practices with 1 to 5 physicians than practices with 6 or more physicians. Adoption rates were similar at independent practices and nonacademic systems; however, both practice types had lower adoption than academic systems (independent practice difference, −6 [95% CI, −9 to −3] percentage points; nonacademic systems difference, −9 [95% CI, −11 to −6] percentage points).Conclusions and RelevanceIn this cohort study of Medicare claims, practice characteristics, especially practice size and rural location, were associated with adoption of immunotherapy. These findings suggest that there may be geographic disparities in access to important innovations for treating patients with cancer.

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The Oncology Care Model and Adherence to Oral Cancer Drugs: A Difference-in-Differences Analysis

Cited by 7 publications

References 31 publications

Medicare’s Bundled Payment Models—Progress and Pitfalls

Medicare’s Bundled Payment Models—Progress and Pitfalls

Medicare Spending, Utilization, and Quality in the Oncology Care Model

Adoption of Innovative Therapies Across Oncology Practices—Evidence From Immunotherapy

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