Characteristics of Physicians Participating in Medicare's Oncology Care Model Bundled Payment Program.

Autor:	Parikh RB; University of Pennsylvania, Philadelphia, PA.; Department of Medical Ethics and Health Policy and the Leonard Davis Institute of Health Economics, Philadelphia, PA.; Corporal Michael J. Cresenz VA Medical Center, Philadelphia, PA., Bekelman JE; University of Pennsylvania, Philadelphia, PA.; Department of Medical Ethics and Health Policy and the Leonard Davis Institute of Health Economics, Philadelphia, PA., Huang Q; Department of Medical Ethics and Health Policy and the Leonard Davis Institute of Health Economics, Philadelphia, PA., Martinez JR; Department of Medical Ethics and Health Policy and the Leonard Davis Institute of Health Economics, Philadelphia, PA., Emanuel EJ; Department of Medical Ethics and Health Policy and the Leonard Davis Institute of Health Economics, Philadelphia, PA., Navathe AS; Department of Medical Ethics and Health Policy and the Leonard Davis Institute of Health Economics, Philadelphia, PA.; Corporal Michael J. Cresenz VA Medical Center, Philadelphia, PA.
Jazyk:	angličtina
Zdroj:	Journal of oncology practice [J Oncol Pract] 2019 Oct; Vol. 15 (10), pp. e897-e905. Date of Electronic Publication: 2019 Aug 08.
DOI:	10.1200/JOP.19.00047
Abstrakt:	Purpose: The Oncology Care Model (OCM) is Medicare's first bundled payment program for patients with cancer. We examined baseline characteristics of OCM physician participants and markets with high OCM physician participation to inform generalizability and complement the ongoing practice-level evaluation of the OCM. Methods: In this cross-sectional study, we identified characteristics of US medical oncologists practicing in 2016, using a national telephone-verified physician database. We linked these data with Dartmouth Atlas and Medicare claims data from 2011 through 2016 to identify characteristics of markets with high OCM participation. We used logistic regression to examine relationships between market characteristics and OCM participation. Results: Of 10,428 US medical oncologists, 2,605 (24.9%) were listed in an OCM practice. There were no differences in sex or medical training between OCM participants and nonparticipants, although OCM participants were slightly younger. OCM participants practiced in larger (median daily patient volume, 80 v 55 patients) and urban practices (95.2% v 90.7%) and were less likely to be part of a health system (41.0% v 60.4%) or solo practice (45.5% v 67.4%; all P < .001). Participation was higher in southern and mid-Atlantic markets. Markets with high OCM physician participation had higher specialist density, hospital care intensity, and acute care use at the end of life (all P < .001). Market-level penetration of Accountable Care Organizations (adjusted odds ratio, 4.65; 95% CI 3.31 to 6.56; P < .001) and Medicare Advantage (adjusted odds ratio 2.82; 95% CI, 1.97 to 4.06; P < .001) were associated with higher OCM participation. Conclusion: In the first description of oncologists participating in the OCM, we found differences in practice demographics, care intensity, and exposure to nontraditional payment models between OCM-participating and nonparticipating physicians. Such provider-level differences may not be captured in Medicare's practice-level analysis.
Databáze:	MEDLINE
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