Paying Cancer Docs to Communicate

If you’re facing a cancer diagnosis, a new program is worth knowing about.

The Centers for Medicare and Medicaid (CMS) has just begun implementing what’s called the Oncology Care Model (OCM). It aims to improve care for those undergoing chemotherapy — and it could be a fantastic resource.

OCM encourages phone contact between physicians to facilitate better coordinated care.

“This program redesigns the practice so [doctors] can begin to focus again on providing coordinated comprehensive care for the patient,” said Terrill Jordan, president and CEO of Regional Cancer Care Associates, one of the clinics participating. His system runs numerous clinics in Washington, D.C., Maryland, and New Jersey.

OCM isn’t available everywhere, however — not yet, anyway. And it works by offering oncologists financial incentives to better communicate and coordinate your treatment.

The Department of Health and Human Services chose only 17 insurance providers and 196 physician practices of those who applied to participate in a pilot phase of the program.

At the core of OCM is an initiative to ensure oncologists are sharing vital information with primary care doctors and other specialists who treat cancer patients undergoing chemotherapy. (No, that doesn’t organically happen.) Separate groups really do have to go out of their way to work together in medicine.

“The more specialized a professional gets, the more siloed they become over time,” Jordan told LifeZette.

Doctors could be paid two ways under OCM: They receive $160 per Medicare fee-for-service beneficiary per month, and then can receive performance-based incentive payments based on care. Patients at OCM-participating clinics do not have to use the program, but the participating clinics will give them the option.

Patients are treated in six-month “episodes” for nearly all types of cancer and it begins when a patient starts chemotherapy.

Patients are treated in six-month “episodes” for nearly all types of cancer and it begins when a patient starts chemotherapy. If a person requires more chemotherapy at the end of the six months, they begin a new episode. If they enter hospice care, the payments to the physician are discontinued.

Patients pay nothing for the attempt at better care — except, of course, through taxes.

Sharing Patient Information
While it may sound like much of the benefit goes to the physician, the goal truly is better care for the patient. The program focuses on patients undergoing chemotherapy because the treatment can increase patients’ risk for other health ailments, or change their health for the rest of their lives.

OCM encourages phone contact between physicians to facilitate better coordinated care. For instance, if a cancer patient is taking medication for a heart condition administered by their primary care doctor, OCM will ensure the oncologist knows about it. In turn, the oncologist can reach out to the patient’s cardiologist if any complications from chemotherapy arise.

Patients won’t be responsible for informing their multiple doctors about meds or treatments or complications, which can get exhausting for someone going through cancer treatment — the program should coordinate care for them.

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“Patients maintain the same relationship with their oncologist and nurses, plus the care team is expanded to include navigators, social workers, dietitians, and counselors, among others,” said Dr. David C. Fryefield, a radiation oncologist at Willamette Valley Cancer Institute and Research Center in Eugene, Oregon. As part of the program, each patient receives a thorough treatment plan, which entails a cancer diagnosis and stage, intent of treatment, prognosis, and risk of side effects. At the end of a course of treatment, each patient receives a survivorship plan.

This more coordinated approach has long been happening in many clinics — especially between doctors in larger health care systems. The problem is it’s been hit or miss.

In Jordan’s clinic, care coordinators will interact with other doctors’ offices to ensure information is shared and that patients are seeing the doctors they need to. Clinics can also help negotiate care costs and organize treatment regimens so that patients will have less of their own legwork to do. OCM should also save patients money because better coordinated care could lead to less visits to the emergency room.

Even after chemotherapy, Jordan said his clinic will continue to manage a coordinated approach to care. Just because an oncologist may no longer be the lead doctor and a patient is in remission, that person still needs to be part of the equation.

“OCM is simply a component of our overall care,” Jordan said. Clinicians in the OCM program “truly believe we need to move from a volume [system] to a value-based high-quality system. We’re trying to ensure all patients have access to high-quality care.”