Annual Report of the Oncology Care Program Course Project

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Annual Report of the Oncology Care Program Course Project

Introduction to Oncology Care Program

Purpose

The Secretary will implement a budget neutral oncology care quality improvement (OCQI) program. The program will evaluate how reporting of quality metrics by participating organizations improve care; how the adoption and application of clinical, evidence-based treatment protocols lead to better patient outcomes; and how adherence to both quality reporting and clinical protocols lowers Medicare expenditures by reducing unnecessary utilization of services, as measured against expenditures for beneficiaries1 with one or more of at least six prevalent cancer conditions including breast, colon, lung and ovarian.

Structure

The OCQI program will compare and evaluate practice patterns and connected clinical improvement and program spending reductions between:

• Self identified community cancer care clinics employing full electronic medical record (EMR) technology and formal, evidence-based treatment protocols3 applicable to patients with the selected diagnoses (intervention group); and

• Cancer treatment centers with parallel patient mix and similar geography but without utilization of full EMRs and without adherence to formal, evidence-based treatment protocols (control group).

The program will last for three years and will require participating organizations to: (1) provide periodic reporting of agreed upon quality metrics and maintain selected patients on clinical, evidence based treatment protocols; and (2) submit to periodic evaluation of clinical improvements (e.g., lower utilization of supportive care drugs, lower mortality, and fewer hospital admissions) and lowered program costs, arising out of program participation.

To evaluate performance, Sunshine Hospital will establish a uniform baseline measure of program spending for cancer patients with the selected diagnoses, inclusive of all inpatient and outpatient costs, including Part D. The financial performance of the intervention group will be judged against the performance of the control group on a periodic basis. Participation in the program would be voluntary and will not change the amount, duration, or scope of fee-for-service (FFS) Medicare benefits. The program would be designed to operate within the FFS structure and would not require participating organizations to submit to capitation.

The principal objective of the OCQI program will be to evaluate and reward new clinical strategies to improve quality of oncology care and improve beneficiary and provider satisfaction, cost-effectively, for Medicare FFS beneficiaries with cancer. The expectation is that reporting of quality metrics and adherence to protocols will identify scalable, replicable improvements in oncology care quality that can be expanded nationally.

Oncology Program Narrative Report

The basic design of the proposed financing is derived from the structure of a Sunshine Hospital notice for voluntary chronic care improvement under traditional FFS Medicare.4 This approach applies a fee-risk model that includes two fees, both financed from anticipating savings yields, one for reporting and one for performance. Participating organizations will hold the latter of the two fees at full risk.

Claims for medical services will continue to be covered, administered and paid to participating organizations under the fee-for-service Medicare program. The first fee, the reporting fee, will be considered a programmatic administrative fee, and no beneficiary coinsurance or deductible will be applied.5 Specific ...