Oncology practice changes during a multistep Oncology Care Model practice transformation project.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 88-88
Author(s):  
Debra Wujcik ◽  
Susan T. Owenby ◽  
Moh'd M. Khushman ◽  
Daniel Cameron ◽  
Thomas Wayne Butler ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Nurse Practitioners ◽  
Organizational Support ◽  
Statistical Significance ◽  
Performance Status ◽  
Cost Of Care ◽  
Care Model ◽  
Oncology Care ◽  
Ed Visits

88 Background: Treatment of lung cancer has seen a paradigm shift in recent years. While the availability of newer treatment options such as targeted therapy and immunotherapy have provided new hope for better outcomes, this has added to the cost of care. Participation in the Center for Medicare Services’ Oncology Care Model (OCM) provides opportunities for oncology practices to identify practice transformation (PT) change strategies that result in improved quality of care (QOL) and cost savings. Methods: A lung cancer PT team convened to facilitate changes that improve patient outcomes and decrease costs at an OCM organization. The year-long project included clinical treatment updates, quantitative and qualitative assessments, and data sharing. Practice changes focused on biomarker driven treatment selection, nurse navigation to better manage symptoms and decrease emergency department (ED) visits and hospitalizations, and earlier advanced care planning (ACP) discussions. Surveys were completed by oncology physicians and nurse practitioners at baseline (n = 9) and end of the project (n = 7). Results: After education, there were more correct responses in 3 of 6 knowledge questions and providers noted less concern about performance status or co-morbidities when prescribing immunotherapy. Providers noted fewer barriers with biomarker documentation; self-reported confidence in 4 questions of biomarker selection was unchanged. Providers reported increased participation of nurse navigators to impact ED visits and hospitalizations over time. Documentation of ACP discussions increased, 42% (8/19) to 56% (13/23), but did not reach statistical significance due to sample size. Although providers reported changes toward earlier ACP discussions, 1 in 3 still wait until performance status declines to initiate discussion. Conclusions: Systematic PT can improve quality of patients care and measures used in value-based care reimbursement models. Providers need ongoing education, practice feedback, and organizational support to effect positive practice changes. In addition, new strategies to increase provider ability to initiate end of life discussions need to be explored.

Potential Winners and Losers: Understanding How the Oncology Care Model May Differentially Affect Hospitals

2021 ◽  
pp. OP.21.00050
Author(s):  
Joel E. Segel ◽  
Eric W. Schaefer ◽  
Nicholas G. Zaorsky ◽  
Christopher S. Hollenbeak ◽  
Haleh Ramian ◽  
...  
Keyword(s):  
Medical School ◽  
Care Model ◽  
For Profit ◽  
Medicare Data ◽  
Higher Ed ◽  
Oncology Care ◽  
Ed Visits ◽  
Breast And Prostate Cancer ◽  
Expected Mortality ◽  
Rural Patients

PURPOSE: With the introduction of the Oncology Care Model and plans for the transition to Oncology Care First, alternative payment models (APMs) are an increasingly important piece of the oncology care landscape. Evidence is mixed on the Oncology Care Model's impact on utilization and costs, but as policymakers consider expansion of similar models, it is critical to understand the characteristics of hospitals that may be differentially affected. METHODS: We used 2007-2016 SEER-Medicare data to identify patients with breast and prostate cancer receiving chemotherapy, endocrine therapy (breast), or androgen deprivation therapy (prostate). For each hospital, we calculated 6-month expected mortality, emergency department (ED) visits, inpatient admissions, and costs, all commonly collected APM outcomes. After calculating observed-to-expected rates for each outcome by hospital, we estimated the association between observed-to-expected rates and characteristics of each hospital to understand hospital characteristics that might be associated with higher- or lower-than-expected rates of each outcome. RESULTS: Hospitals with > 15% rural patients had significantly higher-than-expected mortality (0.31 points higher, P < .001) and ED visit rates (0.10 points higher, P = .029) as well as significantly lower costs (0.06 points lower, P = .004). Hospitals unaffiliated with a medical school also experienced significantly higher-than-expected mortality and ED visits. Hospitals eligible for disproportionate share hospital payment experienced significantly higher ED visits but lower costs. For-profit hospitals experienced higher-than-expected mortality. CONCLUSION: Rural hospitals and those unaffiliated with a medical school may require special consideration as APMs expand in oncology care. Designated cancer centers and larger hospitals may be advantaged.

Breast Cancer Stage Is Associated With Exceeding Target Price in the Oncology Care Model

2021 ◽  
Author(s):  
Ryan B. Thomas ◽  
Vittorio Maio ◽  
Anna Chen ◽  
Seojin Park ◽  
Dexter Waters ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Academic Medical Center ◽  
Stage Iv ◽  
Cost Of Care ◽  
Mean Difference ◽  
Cancer Stage ◽  
Care Model ◽  
Target Price ◽  
Old Patients ◽  
Oncology Care

PURPOSE: To explore mean difference between Oncology Care Model (OCM) total costs and target price among breast cancer episodes by stage under the Centers for Medicare and Medicaid Services OCM payment methodology. METHODS: Breast cancer episodes from OCM performance period 1-4 reconciliation reports (July 1, 2016-July 1, 2018) were linked with health record data from a large, academic medical center. Demographics, total cost of care (TCOC), and target price were measured by stage. Adjusted differences between TCOC and target price were compared across cancer stage using multivariable linear regression. RESULTS: A total of 539 episodes were evaluated from 252 unique patients with breast cancer, of which 235 (44%) were stage I, 124 (23%) stage II, 33 (6%) stage III, and 147 (27%) stage IV. About 37% of episodes exceeded target price. Mean differences from target price were –$1,782, $2,246, –$6,032, and $11,379 all in US dollars (USD) for stages I through IV, respectively. Stage IV episodes had highest mean TCOC ($44,210 USD) and mean target price ($32,831 USD) but also had higher rates of chemotherapy, inpatient admission, and novel therapy use. After adjusting for covariates, stage IV and ≥ 65-year-old patients had the highest mean difference from target price ($17,175 USD; 95% CI, $12,452 to $21,898 USD). CONCLUSION: Breast cancer episodes in older women with distant metastases most frequently exceeded target price, suggesting that target price did not adequately account for complexity of metastatic cancers. A metastatic adjustment introduced in PP7 represents a promising advancement in the target price methodology and an impact evaluation will be needed.

Efficient and Effective Models for Integrating Advanced Practice Professionals into Oncology Practice

2013 ◽  
pp. e377-e379
Author(s):  
Lawrence N. Shulman
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Models Of Care ◽  
Advanced Practice ◽  
Practice Style ◽  
Oncology Care ◽  
Oncology Practice ◽  
Effective Models

Advanced practice professionals (APP), primarily nurse practitioners and physician assistants, are increasingly being integrated into oncology practices. The reasons are numerous, and models of care options are numerous as well. Models of care have developed without much forethought and are often the result of the relative interests of the physician, the APP, and the mutual “comfort” of practice style. The increasing complexity of oncology care, the pressures of the health care crisis and health care reform mean that it is necessary that we examine models of collaborative care in terms of both quality of care and productivity.

Patient-reported symptom burden and quality of life in advanced lung cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16570-e16570
Author(s):  
Shrividya Iyer ◽  
Alex Rider ◽  
Gavin Taylor-Stokes ◽  
Adam Roughley
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Performance Status ◽  
Symptom Burden ◽  
Shortness Of Breath ◽  
Patient Reported ◽  
And Performance ◽  
Loss Of Appetite ◽  
Nsclc Patients

e16570 Background: The main objective of our study was to assess patient reported symptom burden and impact on quality of life in advanced non small cell lung cancer (NSCLC) patients in the United States. Methods: Patients with advanced (stage IIIB/IV) NSCLC (N=450) were recruited with informed consent in a nationwide (US) lung cancer study from Oct-Dec 2011. Patient reported symptoms were assessed using the Lung Cancer Symptom Scale (LCSS) on a 0-100 visual analogue scale and included six symptoms: fatigue, appetite loss, shortness of breath, cough, pain and blood in sputum. An average symptom burden index was calculated. Quality of life was assessed using the Functional Assessment of Cancer Therapy- Lung (FACT-L).Higher scores indicate higher symptom severity on the LCSS and better quality of life on the FACT-L. Correlation between the total FACT-L score and LCSS symptom burden index was assessed. A multivariate regression analysis was performed with FACT-L total score as the dependent variable and LCSS symptom scores as predictors controlling for age, gender, stage and performance status. Results: Majority of the patients were male (59%), Caucasian (74%), smokers/ex-smokers (78%) with an average age of 64 years. Proportion of patients reporting each lung cancer symptom was: Fatigue (100%), loss of appetite (97%), shortness of breath (95%), cough (93%), pain (92%) and blood in sputum (63%). The average (SD) symptom burden index was 42.3 (21.5).The mean± SD severity scores on symptoms were: fatigue (53.2±24.7), loss of appetite (48.1±25.8), cough (48.4±29.9), shortness of breath (44.7± 27), pain (39.7± 28.1) and blood in sputum (18.4±23.6). The average (SD) FACT-L score was 71.7 (25.3). A significant negative correlation was found between the LCSS symptom burden index and FACT-L scores (ρ= -0.82; p<0.001). Loss of appetite (β=-0.204; p<0.001), cough (β= -0.145; p<0.01), pain (β=-0.265; p<0.001), shortness of breath (β = -0.145; p<0.01), age (β= 0.217; p<0.05) and performance status (β = 0.283; p<0.001) were found to be significant predictors of quality of life. Conclusions: Cough, pain, shortness of breath and loss of appetite contribute to symptom burden and have a significant negative impact on quality of life in advanced NSCLC patients.

A process for improving patient survey scores in the oncology care model (OCM).

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 222-222 ◽  
Author(s):  
Manuel Perry ◽  
Katie Rudy-Tomczak ◽  
Scott Hines
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Patient Survey ◽  
Dramatic Improvement ◽  
Shared Decision ◽  
Institute Of Medicine ◽  
Care Model ◽  
Oncology Care

222 Background: The Oncology Care Model is an alternative payment model created by The Center for Medicare and Medicaid Services. Our goal was to improve patient education and to improve the patient experience. We hired nurse practitioners to achieve this. Methods: Crystal Run Healthcare is a multi-specialty group practice with nine oncologists. A total of 4 nurse practitioners have been hired since implementation of the OCM Program in July 1, 2016. All oncology patients and their family who are scheduled to initiate a new treatment program or a change in an existing treatment are scheduled to meet with a nurse practitioner for 60-75 minutes in order to review details of their treatment including a 13-point treatment summary recommended by the Institute of Medicine. Results: CMS administered anonymous patient surveys at baseline and in rolling 6 month episodes reported every 3 months. Data is represented from January-September 2016 (baseline)and is compared to July 2016-March 2017. Since implementation of our nurse practitioner access program, patient survey scores improved dramatically. Average overall rating improved from the 11th-20th percentile to 71st-80th percentile. The most dramatic improvement occurred in shared decision making which improved from 11th-20th percentile to the 91st-99th percentile. Conclusions: The addition of nurse practitioners who are tasked with educating patients regarding their treatment offers an opportunity for patients to have a comprehensive visit to review treatment details. The most striking improvement was seen in shared decision making which likely reflects the benefits of a prolonged discussion between the nurse practitioner, the patient and their family.[Table: see text]

scholarly journals Impact of molecular alterations on quality of life and prognostic understanding over time in patients with incurable lung cancer: a multicenter, longitudinal, prospective cohort study

2021 ◽  
Author(s):  
Jonas Kuon ◽  
Miriam Blasi ◽  
Laura Unsöld ◽  
Jeannette Vogt ◽  
Anja Mehnert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Psychological Distress ◽  
Performance Status ◽  
Multicentric Study ◽  
Molecular Alterations ◽  
Prospective Longitudinal ◽  
The Impact ◽  
Over Time

Abstract Purpose The purpose of this study is to investigate changes over time in quality of life (QoL) in incurable lung cancer patients and the impact of determinants like molecular alterations (MA). Methods In a prospective, longitudinal, multicentric study, we assessed QoL, symptom burden, psychological distress, unmet needs, and prognostic understanding of patients diagnosed with incurable lung cancer at the time of the diagnosis (T0) and after 3 (T1), 6 (T2) and 12 months (T3) using validated questionnaires like FACT-L, National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT), PHQ-4, SCNS-SF-34, and SEIQoL. Results Two hundred seventeen patients were enrolled, 22 (10%) with reported MA. QoL scores improved over time, with a significant trend for DT, PHQ-4, and SCNS-SF-34. Significant determinants for stable or improving scores over time were survival > 6 months, performance status at the time of diagnosis, and presence of MA. Patients with MA showed better QoL scores (FACT-L at T1 104.4 vs 86.3; at T2 107.5 vs 90.0; at T3 100.9 vs 92.8) and lower psychological distress (NCCN DT at T1 3.3 vs 5; at T2 2.7 vs 4.5; at T3 3.7 vs 4.5; PHQ-4 at T1 2.3 vs 4.1; at T2 1.7 vs 3.6; at T3 2.2 vs 3.6), but also a worsening of the scores at 1 year and a higher percentage of inaccurate prognostic understanding (27 vs 17%) compared to patients without MA. Conclusion Patients with tumors harboring MA are at risk of QoL deterioration during the course of the disease. Physicians should adapt their communication strategies in order to maintain or improve QoL.

scholarly journals Innovative Models for High-Risk Patients Use Care Coordination and Palliative Supports to Reduce End-of-life Utilization and Spending

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Sarah Ruiz ◽  
Lynne Page Snyder ◽  
Katherine Giuriceo ◽  
Joanne Lynn ◽  
Erin Ewald ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
End Of Life ◽  
Care Coordination ◽  
Cost Of Care ◽  
Care Transition ◽  
Care Planning ◽  
Care Model ◽  
Advance Care

Abstract Background and Objectives Care coordination and palliative care supports are associated with reduced anxiety, fewer hospital admissions, and improved quality of life for patients and their families. Early palliative care can result in savings in the end-of-life period, but there is limited evidence that larger-scale models can improve both utilization and the cost of care. Three models that received Health Care Innovation Awards from the Centers for Medicare & Medicaid Services aimed to improve quality of care and reduce cost through the use of innovative care coordination models. This study explores the total cost of care and selected utilization outcomes at the end-of-life for these innovative models, each of which enrolled adults with multiple chronic conditions and featured care coordination with advance care planning as a component of palliative care. These included a comprehensive at-home supportive care model for persons predicted to die within a year and two models offering advance care planning in nursing facilities and during care transitions. Research Design and Methods We used regression models to assess model impacts on costs and utilization for high-risk Medicare beneficiaries participating in the comprehensive supportive care model (N = 3,339) and the two care transition models (N = 587 and N = 277) who died during the study period (2013–2016), relative to a set of matched comparison patients. Results Comparing participants in each model who died during the study period to matched comparators, two of the three models were associated with significantly lower costs in the last 90 days of life ($2,122 and $4,606 per person), and the third model showed nonsignificant differences. Two of the three models encouraged early hospice entry in the last 30 days of life. For the comprehensive at-home supportive care model, we observed aggregate savings of nearly $19 million over the study period. One care transition model showed aggregate savings of over $500,000 during the same period. Potential drivers of these cost savings include improved patient safety, timeliness of care, and caregiver support. Discussion and Implications Two of the three models achieved significant lower Medicare costs than a comparison group and the same two models also sustained their models beyond the Centers for Medicare & Medicaid Services award period. These findings show promise for achieving palliative care goals as part of care coordination innovation.

Actigraphy as an assessment of performance status in patients with advanced lung cancer

2019 ◽  
Vol 17 (5) ◽  
pp. 574-578 ◽  
Author(s):  
Daisuke Fujisawa ◽  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Areej El-Jawahri ◽  
Lara Traeger ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Performance Status ◽  
Small Cell ◽  
Small Cell Lung ◽  
Trial Outcome Index ◽  
Therapy Trial ◽  
Outcome Index ◽  
Time Awake ◽  
Ecog Ps

AbstractObjectiveWearable devices such as a wrist actigraph may have a potential to objectively estimate patients’ functioning and may supplement performance status (PS). This proof-of-concept study aimed to evaluate whether actigraphy data are significantly associated with patients’ functioning and are predictive of their survival in patients with metastatic non-small cell lung cancer.MethodWe collected actigraphy data for a three-day period in ambulatory patients with stage IV non-small cell lung cancer. We computed correlations between actigraphy data (specifically, proportion of time spent immobile while awake) and clinician-rated PS, subjective report of physical activities, quality of life (the Functional Assessment of Cancer Therapy – Trial Outcome Index), and survival.ResultActigraphy data (the proportion of time awake spent immobile) were significantly correlated with Functional Assessment of Cancer Therapy – Trial Outcome Index (r = −0.53, p < 0.001) and with the Eastern Cooperative Oncology Group PS (ECOG PS) (r = 0.37, p < 0.001). The proportion of time awake spent immobile was significantly associated with worse survival. For each 10% increase in this measure, the hazard ratio (HR) was 1.48 (95% confidence interval [CI95%] = 1.06, 2.06) for overall mortality, and odds ratio was 2.99 (CI95% = 1.27, 7.05) for six-month mortality. ECOG PS was also associated with worse survival (HR = 2.80, CI95% = 1.34, 5.86). Among patients with ECOG PS 0-1, the percentage of time awake spent immobile was significantly associated with worse survival, HR = 1.93 (CI95% = 1.10, 3.42), whereas ECOG PS did not predict survival.Significance of ResultsActigraphy may have potential to predict important clinical outcomes, such as quality of life and survival, and may serve to supplement PS. Further validation study is warranted.

The Oncology Care Model: A Critique

2016 ◽  
pp. e109-e114 ◽  
Author(s):  
Christian A. Thomas ◽  
Jeffrey C. Ward
Keyword(s):  
Health Care ◽  
Health Care Expenditures ◽  
Critical Discussion ◽  
Cost Of Care ◽  
Fee For Service ◽  
Care Model ◽  
Patient Admissions ◽  
Pilot Model ◽  
Oncology Care ◽  
The Cost

Rapidly increasing national health care expenditures are a major area of concern as threats to the integrity of the health care system. Significant increases in the cost of care for patients with cancer are driven by numerous factors, most importantly the cost of hospital care and escalating pharmaceutical costs. The current fee-for-service system (FFS) has been identified as a potential driver of the increasing cost of care, and multiple stakeholders are interested in replacing FFS with a system that improves the quality of care while at the same time reducing cost. Several models have been piloted, including a Center for Medicare & Medicaid Innovation (CMMI)–sponsored medical home model (COME HOME) for patients with solid tumors that was able to generate savings by integrating a phone triage system, pathways, and seamless patient care 7 days a week to reduce overall cost of care, mostly by decreasing patient admissions to hospitals and referrals to emergency departments. CMMI is now launching a new pilot model, the Oncology Care Model (OCM), which differs from COME HOME in several important ways. It does not abolish FFS but provides an additional payment in 6-month increments for each patient on active cancer treatment. It also allows practices to participate in savings if they can decrease the overall cost of care, to include all chemotherapy and supportive care drugs, and fulfill certain quality metrics. A critical discussion of the proposed model, which is scheduled to start in 2016, will be provided at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting with practicing oncologists and a Centers for Medicare & Medicaid Services (CMS) representative.

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