CMS’ oncology alternative payment model reduced utilization of imaging services in Medicare
The Centers for Medicare & Medicaid Services’ oncology alternative payment model produced lower utilization of imaging services, according to new research published Tuesday in JAMA.
CMS introduced the five-year, value-based care effort in 2016 aiming to control cancer treatment costs, which reached $200 billion last year. Under the Oncology Care Model, about 200 physician practices inked agreements to bolster coordination and reduce unplanned care for patients receiving chemotherapy.
Researchers sought to analyze the model’s impact on healthcare spending, utilization and quality during the first three years. They found the model was significantly associated with modest decreases, including about 46 fewer imaging services used per 1,000 care episodes.
All told, the Oncology Care Model produced a $297 per-episode decrease in Medicare episode payments (about $18 fewer on imaging), which was insufficient to offset CMS’ investment in the effort.
“The OCM was not associated with a decline in any critical quality measures, and this negative result is noteworthy,” Raymond Osarogiagbon, MBBS, with Baptist Memorial Health Care Corp. in Memphis, Tennessee, and colleagues wrote in a corresponding editorial. “One of the chief concerns of value-based payment models is the theoretical risk that financial incentives will induce restrictions in essential care. The OCM had no demonstrable adverse effects on care quality and in that important respect represents a positive outcome.”
For their study, Harvard Medical School’s Nancy Keating, MD, and colleagues compared care during six-month episodes at model-participating practices and a comparison group that did not. All told, the analysis included more than 483,000 Medicare fee-for-service beneficiaries treated by 201 OCM practices, along with more than 557,000 cared for at 534 comparison practices. Keating et al. tracked a baseline period for before the payment model (January 2014 to June 2015) and after its initiation (July 2016 to December 2018).
Total episode payments for participating practices increased from $28,681 to $33,211 compared to an increase of $28,421 to $33,249 for comparison episodes. Drug prices accounted for most of the change at 57%. Calculating a “difference-in-differences,” the authors determined OCM was associated with a $297 lower increase over the study period. Meanwhile, average imaging costs climbed from $812 to $824 in the intervention group versus $814 to $843 in the comparison group, for a difference-in-differences of $18 or a -2.2% change. Authors also estimated a roughly 1% decrease in the use of imaging services per episode versus the comparison group.
Read more about their work in the American Medical Association’s flagship journal here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.