Oncology Practice Administrators Discuss Early Findings From the OCM
Surabhi Dangi-Garimella, PhD
Oncology practices that are participating in the Center for Medicare & Medicaid Innovation’s Oncology Care Model (OCM) have started receiving performance feedback from CMS. At the 2017 Community Oncology Conference, held April 26-27 at the Gaylord National Hotel and Convention Center in National Harbor, Maryland, practice administrators from 2 community clinics discussed the changes they made to their practice to accommodate the reporting requirements, and the follow-up planned as they work to implement changes.
The panel, moderated by Robert Baird Jr, RN, MSA, CASC, CEO, Dayton, Physicians Network, included Alti Rahman, MHA, MBA, CSSBB, practice administrator, Oncology Consultants, and Anne Marie Rainey, MSN, RN, CHC, compliance & quality control officer, Clearview Cancer Institute.
When queried on how their practices accommodated participation in OCM, Rainey said that as with any new program, “You think it’s going well some days, but on other days we don’t.” She explained that while there are a lot of positives to participating in OCM, “we have had to also work to make changes to make this sustainable for our practice—not just OCM, but other reporting requirements as well.”
For Oncology Consultants, the initial challenge was the review of the entire quality reporting aspect within their practice.
“We developed 2 teams: 1 looking at the clinical data and the other focused on quality aspects,” Rahman said. The 2 team leads made sure that operational changes matched the reporting, Rahman said, “Which helped meet the OCM reporting and quality initiatives across our primary and satellite sites.”
According to Rainey, an open-door policy and an emphasis on communication has been key to success.
“We found out early on that in addition to e-mail updates, monthly and quarterly meetings worked well to provide continuous quality feedback for each department,” Rainey said. "We have found unique ways to make this work.”
Both agreed that adequate staffing was of essence to meet the quality and reporting requirements of OCM.
When Baird asked them to identify the major challenges they have faced over the past year with OCM implementation, Rainey noted that workflow changes were the hardest barrier to overcome. There was a lot of resistance from the staff who felt “we were just adding care plan steps or clicks within the workflow. That was initially huge, but we have overcome most of that, although there will always be room for improvements,” she said.
Rahman identified staffing, infrastructure, and information technology needs as the challenges, a majority of which he said were related to operational and reporting requirements. Another major challenge was getting a grip on the cost of managing the manual abstraction of data from the electronic health records. “We had to look at the costs of manual versus automated data abstraction.”
Constructive Lessons Learned
Rainey identified a big advantage of the patient-centered aspect of OCM.
“It forced us to communicate more with our patients and document things that were historically not documented," she said. "For example, we were not documenting advance care directives for our patients.”
The clinic identified this as an area that needed improvement and now 75% of their Medicare patients have these directives documented. “It can be uncomfortable for our staff as well as patients, but we are proud that we have championed this,” she said.
Both Rahman and Rainey reiterated that communication across the various departments in their respective organizations was key to identifying problem areas and working to implement changes.
Baird was curious to find out the patient feedback when informed that the clinic would be participating in a new type of reimbursement model.
“We opted to mail a letter to Medicare and on-chemotherapy patients,” Rainey told the audience. While they had a lot of questions initially, they were also happy to see more information on their care plan and medications, she said.
Rahman’s practice devised a strategy to make the information more patient friendly. “The letter can be dense, and so we created a cartoon to help patients understand their plan better. We needed to supplement the letter and explain it better,” he said.
The first wave of OCM feedback reports, for practices that had 6-month chemotherapy episodes, are out. Rainey said that while the reports were a little overwhelming, initially, they soon noticed trends as they dug deeper. “We noticed that E&M [evaluation and management] visits were high for our practice and when we looked closer, it helped us locate an outlier physician.” She also explained how they placed triage pathways in place to reduce the number of hospital and emergency room (ER) visits for patients who were troubled with nausea, vomiting, and diarrhea.
“We need to get a deeper dive into this, with the help of data analytics companies, to avoid a knee-jerk reaction so we can plan this out better,” Rainey added.
Rahman’s practice also focused on ER utilization and they were able to point out the exact dollars associated with patient visits to various hospitals across Houston and the variation seen for the same treatment. “But we have to partner with analytics companies and we’d need this data more frequently,” he said.
Rahman emphasized that while their practice has extended hours, raising patient awareness to call or come to the clinic instead of visiting a hospital or the ER is vital.