Dr Barbara McAneny Discusses the Continuing Evolution of the COME HOME Model
As more practices adopt the COME HOME model, they are adapting it to fit their needs, explained Barbara McAneny, MD, chief medical officer of New Mexico Oncology Hematology Consultants. However, some practices may not have the resources to keep up with data collection requirements while ramping up clinical interventions.
Transcript (slightly modified) How has the COME HOME model changed over the years?
At the beginning of COME HOME, it was 7 practices across the country. My practice, New Mexico Cancer Center, had done a lot of these policies and procedures because I take care of poor people, and having them be able to afford cancer care was obviously very important. As we moved it to the other practices, it had to adapt a little bit to work in each individual market. Some of the practices just did their Medicare patients; some like New Mexico Cancer Center expanded and did these processes for all of our patients.
It has changed a bit when it turned into the Oncology Care Model. The data collection requirements and the idea of superimposing the risk structure, this payment structure, on top of it is very different. When we did COME HOME, we added up all the costs of paying nurses to sit on the phone talking to patients as part of the triage pathway, the extra time it takes to have nurses and others educating patients as to how their disease would work and how to use our system to keep themselves healthy, and be able to have the opportunity costs of having expanded hours and having the ability to see patients the day they need to be seen.
When we added up all those costs, it came out more than the $160 per month that is the MEOS [Monthly Enhanced Oncology Services] payment, so I’m concerned that as it goes towards Medicare that practices will not have sufficient resources to really ramp up the clinical interventions that they need in their practices to really make it work. I also think that there’s a risk, like there was with the accountable care organizations, that all of the money paid in the MEOS payment will go towards the data collection to give back to Medicare, and that’s not really the intent.