Association of Participation in the Oncology Care Model With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes.

Autor:	Keating NL; Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Jhatakia S; The Lewin Group, Falls Church, Virginia., Brooks GA; Geisel School of Medicine, Lebanon, New Hampshire., Tripp AS; The Lewin Group, Falls Church, Virginia., Cintina I; The Lewin Group, Falls Church, Virginia., Landrum MB; Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts., Zheng Q; Abt Associates, Cambridge, Massachusetts., Christian TJ; Abt Associates, Cambridge, Massachusetts., Glass R; Abt Associates, Cambridge, Massachusetts., Hsu VD; General Dynamics Information Technology, Falls Church, Virginia., Kummet CM; General Dynamics Information Technology, Falls Church, Virginia., Woodman S; Centers for Medicare & Medicaid Innovation, Baltimore, Maryland., Simon C; The Lewin Group, Falls Church, Virginia., Hassol A; Abt Associates, Cambridge, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA [JAMA] 2021 Nov 09; Vol. 326 (18), pp. 1829-1839.
DOI:	10.1001/jama.2021.17642
Abstrakt:	Importance: In 2016, the US Centers for Medicare & Medicaid Services initiated the Oncology Care Model (OCM), an alternative payment model designed to improve the value of care delivered to Medicare beneficiaries with cancer. Objective: To assess the association of the OCM with changes in Medicare spending, utilization, quality, and patient experience during the OCM's first 3 years. Design, Setting, and Participants: Exploratory difference-in-differences study comparing care during 6-month chemotherapy episodes in OCM participating practices and propensity-matched comparison practices initiated before (January 2014 through June 2015) and after (July 2016 through December 2018) the start of the OCM. Participants included Medicare fee-for-service beneficiaries with cancer treated at these practices through June 2019. Exposures: OCM participation. Main Outcomes and Measures: Total episode payments (Medicare spending for Parts A, B, and D, not including monthly payments for enhanced oncology services); utilization and payments for hospitalizations, emergency department (ED) visits, office visits, chemotherapy, supportive care, and imaging; quality (chemotherapy-associated hospitalizations and ED visits, timely chemotherapy, end-of-life care, and survival); and patient experiences. Results: Among Medicare fee-for-service beneficiaries with cancer undergoing chemotherapy, 483 319 beneficiaries (mean age, 73.0 [SD, 8.7] years; 60.1% women; 987 332 episodes) were treated at 201 OCM participating practices, and 557 354 beneficiaries (mean age, 72.9 [SD, 9.0] years; 57.4% women; 1 122 597 episodes) were treated at 534 comparison practices. From the baseline period, total episode payments increased from $28 681 for OCM episodes and $28 421 for comparison episodes to $33 211 for OCM episodes and $33 249 for comparison episodes during the intervention period (difference in differences, -$297; 90% CI, -$504 to -$91), less than the mean $704 Monthly Enhanced Oncology Services payments. Relative decreases in total episode payments were primarily for Part B nonchemotherapy drug payments (difference in differences, -$145; 90% CI, -$218 to -$72), especially supportive care drugs (difference in differences, -$150; 90% CI, -$216 to -$84). The OCM was associated with statistically significant relative reductions in total episode payments among higher-risk episodes (difference in differences, -$503; 90% CI, -$802 to -$204) and statistically significant relative increases in total episode payments among lower-risk episodes (difference in differences, $151; 90% CI, $39-$264). The OCM was not significantly associated with differences in hospitalizations, ED visits, or survival. Of 22 measures of utilization, 10 measures of quality, and 7 measures of care experiences, only 5 were significantly different. Conclusions and Relevance: In this exploratory analysis, the OCM was significantly associated with modest payment reductions during 6-month episodes for Medicare beneficiaries receiving chemotherapy for cancer in the first 3 years of the OCM that did not offset the monthly payments for enhanced oncology services. There were no statistically significant differences for most utilization, quality, and patient experience outcomes.
Databáze:	MEDLINE
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