A private urology practice can successfully transform itself in a relatively short time from a fee-for-service payment model for cancer care to an episode-based system, one that urologists at one community practice say provides an opportunity for enhancing quality of care.
It remains to be determined, however, whether operating under the episode-based payment model also translates into cost savings for cancer care delivery, said Jeremy Shelton, MD, MS.
In July 2016, Skyline Urology, a community urology practice in Torrance, CA, was one of two urology-predominant practices that began participation in the Centers for Medicare & Medicaid Services’ episode-based payment model targeting medical management of cancer. Known as the Oncology Care Model (OCM), the episode-based payment model was established under the Medicare Access and CHIP Reauthorization Act of 2015 with the hope of aligning payment incentives to increase quality and lower costs. It provides a per-beneficiary-per-month payment to help fund practice transformation, including enhanced patient navigation, use of data for quality improvement, and use of a certified electronic health record.
In addition, it provides performance-based payments when high-value care is delivered.
At the AUA annual meeting, Dr. Shelton presented findings from a review of Skyline Urology’s first-year experience.
“Skyline Urology, like many large urology practices, has seen the opportunity for improved quality of care in novel payment systems for several years, but despite multiple efforts was unsuccessful in finding an interested payer to partner with. With OCM from the CMS, the practice finally got the chance,” said Dr. Shelton, who was previously a Skyline Urology provider and is now at UCLA’s David Geffen School of Medicine, Los Angeles.
“It is evident from Skyline Urology’s experience that the practice transformation aim of OCM is a success. With the appropriate funding model, the practice was able to deliver components of care, like care coordination and navigation, that are typically missing in a fee-for-service environment. To date, however, the practice has not been able to achieve CMS’s goal of both improving quality of care and reducing costs. It may be that it is too early to tell or perhaps the model, which was developed primarily to target medical oncology practices, needs to be tweaked to make it successful from a cost standpoint when implemented in urology.”
During the first year of Skyline Urology’s participation in the OCM, 574 patients qualified, of whom 76% had prostate cancer, 21% had bladder cancer, and 1% had kidney cancer. In order to provide the additional services stipulated in the OCM program, the practice hired 3.5 full-time employees, including two licensed vocational nurses and 1.5 data analysts. Additionally, under the leadership of Cancer Center Directors and nurse practitioners Shirley Lee and Melanie Reed, Skyline Urology built out a data warehouse for the cancer center patients, physician staff underwent training, and the practice paid for 720 consulting hours for workflow redesign and chart abstraction.
An analysis of patient service delivery showed that the vast majority of patients (84%) had an assessment at least every 6 months for pain, depression, psychosocial needs, and as needed, end-of-life planning. Intervention in these areas was also being provided as needed.