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Pennsylvania-Based Medical Oncology Practice Decreases Hospital Costs

The first oncology practice to be recognized as level III PCMH shows how it’s done

Consultants in Medical Oncology & Hematology (CMOH), a community-based medical oncology practice in Pennsylvania, is explaining how it decreased hospital costs as it became the first oncology practice that NCQA has recognized as a level III patient-centered medical home (PCMH).

“A medical oncology practice can really serve as the hub of coordination and accountability, meeting all cancer care needs,” Dr. John Sprandio, cofounder and chief physician at CMOH, asserted in an Atlantic Information Services report. “It integrates well with primary care PCMH practices, as well as surgical, radiation oncology, and so on.” The model reduces costs by “addressing symptoms in a timely fashion, intervening, and continuing to have a focus on process improvement.”

“We realized years ago that in order for us as physician providers to become more accountable for quality and the consistency of the care as well as the cost, we faced several barriers on our way to really delivering consistent care that was executed in a standardized way from one doctor to the next in our practice of 10 physicians.” About a decade ago, CMOH looked at itself and found “there was great variability in the roles and responsibilities” of the different members of the care team, from administrative assistants to chemotherapy nurses and nurse practitioners.

So CMOH “went on a mission … to streamline our processes of care, take out valueless variation, [and] standardize the roles and responsibilities.” That included turning receptionists into “lay patient navigators” responsible for tasks such as scheduling tests and appointments and helping patients find various resources. Taking away “clinically irrelevant activities from our physicians” gave the providers “the time to make complex medical decisions, … maintain personal relationships with patients and their families, … [and] fix accountability within the care team at the locus of control.”

The practice followed such principles and “developed data systems tracking performance and developed technology support to enable the care team to execute at this level.” By adhering to treatment guidelines and providing the appropriate therapy, CMOH was able to give “rational and informed care.” It increased patients’ access to care and “improved patient navigation, coordination, and communication, and we reduced patients’ avoidable complications and unnecessary utilization of services,” including emergency room trips and hospital admissions.

All of these actions “had a significant impact on costs, as well as the consistency of our execution of care.”

A Milliman analysis of commercially insured patients found an average of two annual emergency room visits per chemotherapy patient among members with cancer. At CMOH, the average visit among all of its patients was 2.6 in 2004, a number that has steadily dropped, reaching 0.5 last year. The same Milliman analysis showed there was about one hospital admission per chemotherapy patient per year. CMOH in 2007 had an average of 1.1 admissions for its total patient population, which had dropped to 0.5 in 2014. Sprandio said there were many reasons for the decreases, but two important ones were allowing timely unscheduled visits and continuous care for and interaction with patients.

He also shared some preliminary risk-adjusted data from one of its local payers on hospitalizations within 60 days of a chemotherapy treatment. For commercial members, “our rate was 33% below the rest of the market,” and it was 61% below the rest of the market for Medicare Advantage members. Emergency room utilization “was also significantly lower on the commercial side.” In the first seven months of the contract with the payer, Medicare Advantage members treated by CMOH had no hospitalizations within the last 30 days of life, compared with the plan benchmark of 0.447. Similarly, none of these CMOH patients received chemotherapy within the last 30 days of life, compared with a benchmark of 0.458. And CMOH-treated patients had an average of 15.25 hospice days during the last 60 days of life, compared with 13.84 days. “Quite frankly, that’s probably not enough — I know it’s not enough — but we beat the rest of the market” by more than 10%, Sprandio said.

Source: Atlantic Information Services; September 8, 2015.

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