Predictors of increased episode expenditure and exceeding target price under the oncology care model
| Autor: | Seojin Park, Dexter Waters, Amy Leader, Ryan B. Thomas, Karen Walsh, Andrew Song, Valerie Pracilio Csik, Vittorio Maio |
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| Rok vydání: | 2020 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 38:e19403-e19403 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | e19403 Background: The Oncology Care Model (OCM) incentivizes participants to keep episode expenditure below target price; however, little is known about the adequacy of adjustments in target price calculation. This study investigates predictors of increased expenditures and explores how these predictors are associated with exceeding target price for hematologic and solid malignancies. Methods: Non-decedent OCM episodes, categorized as hematologic malignancies (HMs) or solid malignancies (SMs), from 7/1/2016 - 7/1/2018 attributed to our institute were analyzed. Multiple linear regression was used to identify factors associated with increased episode expenditure. Multiple logistic regression was used to evaluate whether such factors increased likelihood of expenditure exceeding target price. Results: Of 1,975 episodes, 499 (25.3%) were HMs and 1,476 (74.7%) were SMs. 54.3% of HMs and 35.2% of SMs had episode expenditure exceeding target price. In HMs, novel therapy use (NT), inpatient admission (INPT), Part B drug use (PB), Part D use (PD), and radiation therapy (XRT) were associated with increased episode expenditure. Of those, INPT and PD increased the likelihood of expenditure exceeding target price. XRT decreased the likelihood of expenditure exceeding target price (Table). In SMs, NT, INPT, emergency department visit, home health aides, durable medical equipment use, PB, PD, XRT, and surgery were associated with increased episode expenditure. Of those, NT, INPT, PB and PD increased the likelihood of expenditure exceeding target price. XRT and receipt of surgery decreased the likelihood of expenditure exceeding target price (Table). Conclusions: INPT and PD significantly increased episode expenditures in both HMs and SMs, leading to expenditures exceeding target prices determined by the OCM benchmark risk-adjustments in both cancer types. NT and PB were significant predictors of increased expenditure and the likelihood of exceeding target price in SMs, but not in HMs. Our findings suggest that there may be opportunities to improve the current model by refining the adjustment for these factors to better reflect real world expenditures. [Table: see text] |
| Databáze: | OpenAIRE |
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