Utilization and Cost of Radiation Therapy in the Oncology Care Model: Final Results from Performance Period 1

Abstract

The Oncology Care Model (OCM) is a US Centers for Medicare & Medicaid Services Innovation Center (CMMI)-initiated episode-based advanced alternative payment model (APM). Herein, we detail the utilization and cost of radiation therapy among the Medicare patient population treated in OCM versus comparison practices. We analyzed the evaluation reports of the OCM from Performance Period 1. Performance Period 1 measured outcomes during the intervention period (starting in July 2016 to January 2017) and the baseline period (starting in January 2014 to July 2015). We specifically looked at the number of episodes of radiation therapy delivered per 6-month episode and the cost of radiation therapy as a percentage of the total cost of care (TCOC) per 6-month episode in OCM versus comparison practices. Additionally, we compared total drug costs (Part B Chemo Drug Costs, Part B Non-chemo drug costs, Part B chemo administration costs, Part D chemo drug costs, Part D other drug costs) with total radiation costs (Part B radiation therapy costs). From the baseline period to the invention period, the average number of radiation therapy services per 6-month episode of care decreased from 4.928 to 4.215 (14.5% decrease) among OCM practices versus 5.294 to 4.555 (14.0%) among comparison practices. The table displays the total cost of care (TCOC), drug costs, and radiation therapy costs both in OCM practices and in-comparison practices. Overall, the absolute dollar amount and proportion of the cost spent on radiation therapy decreased in both groups, whereas the absolute amount and proportion of spending spent on drugs increased in both OCM and comparison groups. The results from the OCM Performance Period 1 demonstrate that radiation therapy represents a small proportion of overall health care spending among cancer patients. Overall, radiation spending represented between 2.5% and 3.2% of the spending in the episodes studied, and decreased over the study period, versus drug spending which represented 55.9%-61.3% of overall health spending and increased over the study period. While the publicly available data are limited in scope, these hypothesis-generating findings suggest that the OCM modestly reduced radiation utilization and costs, while the total cost of care and drug costs continue to rise. Further work is urgently needed to study how advanced APMs, such as the Oncology Care First and mandatory radiation oncology APM, impact the appropriate use of and access to radiation therapy services.Abstract 201; TableDrug and Radiation Therapy Costs in the OCM per 6-month episodeOCM BaselineOCM InterventionDiffComparison BaselineComparison InterventionDiffTotal Cost of Care$28,202$30,995$2,793$26,494$29,893$3399Drug Costs$15,965 (56.6%)$18,992 (61.3%)$3,027$14,812 (55.9%)$18,077 (60.5%)$3265Radiation Therapy Costs$832 (3.0%)$783 (2.5%)-$49$836 (3.2%)$834 (2.8%)-$2All other care$11,405 (40.4%)$11,220 (36.2%)-$185$10,846 (40.9%)$10,982 (36.7%)$136 Open table in a new tab