Evaluation of Impact of Radiation Therapy on OCM Episodes: Lessons Applicable to Promoting Value Based Care in the RO-APM

Abstract

In 2017 CMMI implemented the alternative payment model (APM) program to the Merit Based Incentive Payment System. The Oncology Care Model (OCM) is an APM for which a 6 month episode of care is triggered by initiation of chemotherapy. While focused on pharmacologic treatment, utilization of radiation therapy (RT) during an episode is accounted for in the target price on which shared savings in the model is evaluated. Our center has participated in OCM since its inception and is awaiting the radiation oncology specific APM (RO-APM). In preparation, we assessed impact of utilization of RT in our OCM population based on diagnoses targeted in the RO-APM. We hypothesized that lessons learned by assessment of impact of RT on OCM will be directly applicable to advancing value based care (VBC) through improved quality and cost savings in the RO-APM. CMMI has proposed inclusion of 5 primary (prostate, breast, H & N, lung, colorectal) and 2 secondary (bone & brain metastasis) disease sites in the RO-APM. We assessed impact of RT utilization on OCM episodes for primary disease sites, as they are eligible for reconciliation in OCM. For each disease we quantified the % of patients who received RT during an episode at our center between 7/1/16 and 12/31/17. For patients who received RT, we determined actual to target variance in cost, emergency department (ED) and inpatient (IP) utilization variance, and details of expenditures associated with use of RT. With the exception of Lung, RT episode expenditures exceeded those for non-RT, however they were closer to target due to favorable adjustments. Assessment by disease site revealed 97% of the average episode cost differential for Prostate was attributable to RT. RT was also responsible for the majority of the cost differential in H&N and Colorectal episodes. In other diseases, there was more cost diversity, including higher inpatient expenditures for Breast, H&N. ED utilization was uniformly higher for all RT episodes. Assessment of RT utilization in OCM reveals opportunities to advance VBC through measures that address both quality and cost savings for patients in the new RO-APM. Opportunities include use of shorter courses of RT for prostate, breast and bone metastases in line with national standards such as ASTRO guidelines, Choosing Wisely and NQF quality metrics. For diseases such as H&N and Colorectal, rigorous symptom management may result in improved treatment tolerance and avoidance of ED visits and admissions. Focus on implementation of best practices in RO-APM should serve to advance VBC and improve patient experience.Abstract 1137; Table 1Disease% RTAvg Episode $Avg Target $Actual to Target VarianceVarianceED %SiteEpisodesRTNon-RTRTNon-RTRT (%)Non-RT (%)Variance (%)IP %Prostate1530,61020,17125,08914,2992241-14-464Breast934,33714,81234,02212,043123-1812618Lung2938,47850,39960,17738,909-3630-51-326H&N2935,89433,11957,87829,372-3813-452092Colorectal1146,36838,15269,99840,738-34-6-29-2793 Open table in a new tab