Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA). He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.
We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?
The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.
What is the role that data will play?
Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time. RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?” In short, clinical decisions are informed by the data.
Everybody supports quality care. But how do you define and measure quality?
There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer. CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience. No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.
We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?
Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators. In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.
You are members of the Quality Institute. How does being involved with the Quality Institute support your work?
RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.