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Practice Matters
News about health policy and practice management issues of importance to oncologists
Wednesday, July 09, 2014

One of the early pilot programs for a new way to pay for cancer care just released its results. And my reaction is “Wow!” and “Huh?”


The results of UnitedHealthcare’s pilot with five oncology practices is now available online as an Early Release article in the Journal of Oncology Practice. (For OT’s previous coverage, click here and scroll down to “United's 19 Categories, 20 Performance Measures” heading and here.)


The “wow” is this: The use of a bundled-payment system for cancer care yielded a 34 percent reduction in predicted total medical cost without harming patient outcomes.


The “huh?” is this: The key feature of the experimental payment system was to reduce the connection between treatment selection and physician income, on the idea that this would reduce chemotherapy costs. However, chemotherapy drug costs were 179 percent higher than predicted based on a comparison with similar practices.


Despite spending $13 million more on drugs than would have been expected—and UnitedHealthcare was actually expecting to reduce its drug bill—the pilot still saved $33 million on the cost of treating 810 patients during the three-year pilot.


Lee Newcomer, MD, senior vice president for oncology, genetics and women’s health at UnitedHealthcare, and his co-authors (Bruce Gould, MD; Ray D. Page, DO, PhD; Sheila A. Donelan, MS; and Monica Perkins, PhD) say the study data does not allow them to fully understand how the costs savings were achieved—or why the drug costs were so much higher than expected. They do know that hospitalization use and use of therapeutic radiology both decreased, but whether one or both is the magic bullet is not clear.


The authors say they do think that simply getting together to share information was important: “Collaboration was an essential element to the success of the pilot,” they write. “The data for the project were available to all participants. Variation was explicitly discussed as an opportunity for improvement and not a failure of health care delivery. Problem solving involved the participation of physicians, the medical group business executives, nursing staff, and payer staff.”

Tuesday, July 08, 2014

New Mexico Cancer Center (NMCC), one of the pioneers of the oncology medical home model, will be featured in a MEDTalk: Reinventing Patient-Centered Cancer Care webcast starting at 10:30 am ET on Wednesday.   


Everybody interested in the future of cancer care delivery and payment should be tracking what NMCC and the other practices in the COME HOME program are doing. The Centers for Medicare & Medicaid Innovation (CMMI) awarded Barbara McAneny, MD, NMCC CEO, a $20 million grant to test the oncology medical home model because CMS thinks that might be an alternative payment approach that makes cancer care financially sustainable.


Check out this Health Affairs blog post to get a sneak peek on how it’s going. Some of the top health care policy people in the U.S. -- Darshak Sanghavi, MD; Mark McClellan, MD; and Kavita Patel, MD -- all of Brookings Institution, write a brief case study that includes this troubling observation: “NMCC currently receives approximately $70,000 per month from the CMMI grant and has not yet identified a clear strategy to sustain the delivery reforms in the COME HOME care model past the end of the grant (July 2015). As for payment reform options, NMCC has been unable to contract as part of a comprehensive ACO due to local health care market conditions.”


But it also includes this fascinating observation:  “NMCC could potentially use the medical home approach with risk sharing (described above) as a first, interim step toward a bundled payment system, NMCC’s long-term preferred model.”


The “described above” is what you need to pay attention to. The blog post includes a table (see Table 2 about half-way down the post) that shows the level of financial risk to oncologists associated with four alternative cancer care payment approaches. Oncology medical home has minimal risk; bundled payments—identified as NMCC’s true goal—has high risk. That means NMCC is positioning itself to accept a flat rate—and guarantee certain quality standards—to treat a population of cancer patients.


If that is where cancer care is headed, will your practice be ready?

Monday, June 23, 2014

A cancer-specific emergency department is being planned in Ohio -- a 16-bed unit of the new emergency department at Ohio State University Wexner Medical Center will be dedicated to patients of OSU’s James Cancer Hospital and Solove Research Institute, according to Columbus Business First.


The new ED -- part of a $1.1 billion medical center expansion -- will open in August, and the cancer-specific unit will follow next spring. Another huge part of the expansion is creation of the new James to replace the existing cancer hospital. 


The space allows patients to be separated from the general ED population when their immune systems are suppressed.  


Currently, about 8,400 cancer patients each year are treated in the medical center’s emergency department or admitted directly to the James by an emergency basis. Kris Kipp, executive director for patient service and chief nursing officer at the James, told reporter Carrie Ghose that the cancer-specific ED was justified because the hospital has a critical mass of more than 20 emergency cancer patients each day.

In conjunction with the dedicated space, emergency physicians will get extra training in cancer care, the article notes. They will work in the unit with oncology nurses.

OSU officials say they believe this is the first cancer-specific ED within a general ED in the country.

Saturday, June 21, 2014

Oncologists who have been avoiding the government’s Physician Quality Reporting System just lost their excuse for doing so.


Beginning this fall, oncology practices registered with the American Society of Clinical Oncology’s Quality Oncology Practice Initiative will be able to meet the government’s reporting requirements through QOPI. Even better, they will be able to use eQOPI, as the long-awaited ability to submit QOPI data electronically will be available.


“This is something we were intending to do anyway, but it’s been accelerated by probably a year,” because of QOPI’s new status with the Centers for Medicare & Medicaid Services (CMS), said ASCO President Peter Yu, MD.


QOPI, launched in 2006, has grown to include more than 160 quality measures. The reporting system allows oncology practices to benchmark their performance against other practices and track their progress over time. More than 900 practices have submitted data to QOPI at least once.


CMS recently approved QOPI as a clinical data registry for PQRS reporting. That approval stems from the so-called “fiscal cliff” legislation Congress approved in 2013.


Heretofore, most oncologists and other physicians have eschewed PQRS participation on the grounds that submitting data was more of a hassle than the incremental pay bonus was worth. But the math starts going the other way next year; physicians who do not submit quality data to PQRS in 2014 will receive a 1.5 percent cut in their Medicare pay (scroll down to see the PQRS incentives and penalties table).

Friday, June 13, 2014


The 340B drug purchasing program has friends and more friends, but don’t count the Community Oncology Alliance  (COA) among them.


The 340B program allows some hospitals, hospital-owned physician practices and community health centers to buy drugs for much less than most hospitals and independent physician practices can. That seems like a good idea unless you are in the pharmaceutical industry or the Office of Inspector General or an organization that represents oncology practices that do not get 340B pricing.


COA commissioned a report (free registration required), released this week, that says the 340B pricing program has actually increased the cost of cancer care.  The research, conducted by Berkeley Research Group, fuels the argument of those who say 340B pricing prompts hospitals to buy oncology practices so they can make profits on chemotherapy.


The researchers report that at least 120 hospitals with 340B pricing acquired one or more independent oncology practices between 2009 and 2012. Because the cost of cancer care delivered in hospitals is more expensive than in physician-owned practices, the analysts estimate that the Medicare program paid $23 million more and Medicare patients paid $4 million more for cancer care than they would have if those practices had remained independent.


Meanwhile, those who think the 340B program is unfair met this week in Washington to discuss the program. And 340B supporters said that meeting was no fun.