The impact of seasonality with hierarchical condition category coding on Oncology Care Model performance for the U.S. Oncology Network
| Autor: | Jennifer Xiong, Puneeth Indurlal, Hope Ives, Judi Payne-De Bock, Chad Adams, Ramzi Abujamra, Brian Turnwald, Stuart Staggs, Jason Altieri, Rajini Manjunath |
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| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 40:66-66 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | 66 Background: The Oncology Care Model (OCM) is a 6-month, episode-based, Medicare value-based care program, which rewards practices for decreasing the total cost of care (TCOC) compared to a trend adjusted predicted baseline called the benchmark price. The predicted baseline and trend factor are a function of 14 covariates in a generalized linear model with a log link and gamma distribution. Select non-cancer comorbidities, represented by a subset of Hierarchical Condition Category (HCC) flags assigned to the episode in the calendar year when the episode initiates, is a major covariate of the linear model. Patient episodes with one or more HCC flags are expected to have higher episode expenditures and receive a higher adjustment to the benchmark. Here, we seek to describe the seasonality of HCC flags and its impact on the benchmark for OCM episodes in The US Oncology Network (The Network). Methods: All eligible OCM episodes data from 14 practices in The Network participating in the OCM for performance periods (PP) 3-9 were analyzed to measure the average number of HCC flags per episode. The relative contribution of HCC flags to the benchmark was calculated by unraveling the linear model. The difference of the average HCC flags, benchmark, and relative contribution of HCC flags to the benchmark for episodes starting in different quarters of the calendar year were evaluated. Results: Average HCC flags for episodes showed a seasonal decline during each calendar year, with episodes initiating during the first quarter of a calendar year having 16.25% higher HCC flags, compared to those in the last quarter (1.93 vs 1.66 flags). The benchmark and the relative contribution of the HCC flags to the episode benchmark were lower in the last quarter of the year (4% and 16.5% respectively) compared to the first quarter. Episode expenditures did not show a similar seasonality pattern. Conclusions: The assignment of HCC flags based on the episode initiation date, leads to a seasonality effect on the average HCC flags and benchmark for episodes initiating in different parts of the calendar year. The seasonality results from a progressively abbreviated period available to assign HCC flags for episodes initiating later in the calendar year. We also hypothesize that the annual reporting requirement for HCC flags, and risk adjustment coding by professionals at the start of each new calendar year, contributes to this seasonality. The financial impact of seasonality on episodic value-based care model benchmarks necessitates a modified, non-seasonal approach to comorbidity-based risk adjustment. |
| Databáze: | OpenAIRE |
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