The challenges of implementing the CMS oncology care model (OCM) in a large multi-center community oncology practice.

Abstract

115 Background: Our oncology practice has participated in the OCM program since July 2016. The purpose was to build improvement in quality care delivery and create methodology to reduce costs. We peered our work with ten cancer centers from ten states along the east coast. Methods: For all performance periods, we focused on building our strengths via five teams: Access, Care Mgmt., Post-acute transition, Finance, and Reporting. A registry was created in Epic. Data was collated and categorized as “OCM Eligible” and “OCM patients.” The Care Team worked with IT to create beneficiary identifications, discrete chart elements, financial estimations, and reports. Results: From Oct. to Dec. 2017 (latest quarter review), 589 patients were attributable. Our black and Hispanic population was +72.9% and +413.3% v. OCM (+76.6% and +381.2% v. all). We were categorized as high risk in the hierarchal condition category: +14% v. OCM, +17.7% v. all at the 25th percentile; +21.6% and +32.6% at the 50th percentile, +14.2% and +17.5 % at the 75th percentile respectively. Our dually enrolled, Medicare / Medicaid was 29% (+113% v. OCM). ED visit utilization was +2.6% (not leading to admits or observations (Obs). IP admits were utilized at a rate of 27.3 per 100 beneficiaries v. 25.8 for OCM (+5.9%) and 26.1 for all (+4.9%). Those that resulted from ED visits only were 15.8 v. 16.2 (-2.5%). Those resulted from Obs were 0.8 v. 0.3 OCM (+142.4%). Unplanned readmits within 30 days were 6.4 (per 100) v. 5.7 OCM (+13.9%). Imaging utilization was -35.2% v. OCM and -38.5% v. all. Hospice use was 3.7% v. a 5% median OCM rate. Home health was +26% v. OCM and +15.8% v. all. Risk-adjusted four Qtr. avg. expenditures were +14.5% per beneficiary v. OCM (Jan. – Dec. 2017); however, mortality rates were -10.9% v. OCM. Conclusions: Our practice data led us to identify and prioritize PI initiatives, helped us engage providers, and educate stakeholders. While certain costs were lower, drug utilization remains high. The ED and IP admits from Obs have been a challenge, even with phone triage assistance developed previously as participants of the ASCO Quality Training Program. Our PI plan is to develop oncology expanded care clinics to reduce ED and Obs utilization.