[[{"@type":["BlogPosting"],"@id":"https:\/\/www.regionalcancercare.org\/news\/cms-value-model-doesnt\/#BlogPosting","@context":{"@vocab":"http:\/\/schema.org\/","kg":"http:\/\/g.co\/kg"},"url":["https:\/\/www.regionalcancercare.org\/news\/cms-value-model-doesnt\/","https:\/\/www.regionalcancercare.org\/news\/cms-value-model-doesnt\/"],"publisher":[{"@id":"https:\/\/www.regionalcancercare.org\/"}],"author":[{"@type":"Organization","@id":"https:\/\/www.regionalcancercare.org\/news\/cms-value-model-doesnt\/#BlogPosting_author_Organization","name":"Regional Cancer Care Associates"}],"inLanguage":"en-US","headline":"CMS Value Model Doesn\u2019t Do It All","dateModified":"2021-11-11T15:05:07+00:00","datePublished":"2016-09-23T11:59:25+00:00","articleBody":"\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tSeptember 23, 2016\t\t\t\t\t\n\t\t\t\t\t\t\t\t\n\t\t\t\t\nAddressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.\nOncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?\nPecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We\u2019re not measuring overall survival, progression-free survival, time to best response. We\u2019re not measuring incidence and severity of toxicities. We\u2019re not looking at whether or not the drugs cured people. We\u2019re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?\nSo, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don\u2019t think we\u2019re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don\u2019t need it, and if you have an alternative\u2014 going to your doctor\u2019s office because they\u2019re open later\u2014and you have a care coordinator who gets you in to see the doctor sooner\u2014so that if you\u2019re nauseous, you don\u2019t wind up dehydrated and in kidney failure but in fact you get an IV\u2014those are all good things. But that\u2019s kind of snipping around the edges. It doesn\u2019t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?\nWell, MEOS payments are strictly for care management, in essence. And I think probably they\u2019ll be OK for care management. They\u2019re not going to cover the cost of being innovative. They\u2019re not going to cover the cost of doing clinical trials. They\u2019re not going to cover the cost of care redesign. For basic care management\u2014avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today\u2014I think MEOS payments will do that.\nRCCA already has value embedded in itself because we\u2019ve already been in value-based contracting. With Horizon, we\u2019re doing bundles; with Cigna, we\u2019re doing the Oncology Medical Home; with Aetna, we\u2019re doing a version of the medical home; with UnitedHealthcare, we\u2019re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it\u2019s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.\nI think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It\u2019s not clear yet. What we\u2019re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven\u2019t made it clear yet. They\u2019re still in the process of getting that done.\nWell, getting rid of SGR is a clear improvement. MACRA and its implications, it\u2019s just going to take a little more time. Here\u2019s the fundamental problem: it sounds obvious, but it\u2019s obviously not obvious. Doctors have a day job. They get up, it\u2019s 5 in the morning, 6 in the morning. They have to go to work. They take care of\u2014particularly in cancer\u2014critically ill people. They\u2019re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.\nSo, change at this level, where do you fit it in? It\u2019s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: \u201cI can\u2019t walk anymore!\u201d; \u201cI can\u2019t move my arm!\u201d; \u201cI can\u2019t breathe!\u201d That\u2019s medicine. I think that there\u2019s a real lack of appreciation of that. Having said that, there\u2019s nothing wrong with MACRA.\nMACRA is the right way to go. It\u2019s good to know that Andy Slavitt is thinking about maybe slowing it down a little\u2014but you\u2019ve got to get there. It\u2019s a difficult thing. It\u2019s not like the government has unlimited funds that they can say, \u201cOK, doctors work half-time and put this in place, and we\u2019ll take care of the rest of the patients.\u201d\nI think it\u2019s more queries of what precisely do you mean here? How will this be measured? It was very\u2014I don\u2019t want to say very\u2014there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it\u2019s not is imprecise. If they say \u201cA,\u201d they mean \u201cA,\u201d so we need to understand it.\nWell, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.\nWe think it\u2019s counterproductive. It\u2019s professionally insulting to suggest that we\u2019re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it\u2019s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications\u2014particularly if we\u2019re doing buy-and-bill where we\u2019re taking the risk of thousands of dollars or tens of thousands of dollars of inventory\u2014for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don\u2019t understand this. This is where I think we\u2019ve made a wrong turn. Our government has made a wrong turn.\nWell, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it\u2019s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they\u2019re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don\u2019t have a lot of time.\nHowever, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you\u2019re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.\nI think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value\u2014value being clinical outcome divided by total cost of care. We\u2019re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.\nWhen a patient has cancer and they come to a cancer doctor, they\u2019re not thinking about value. They\u2019re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that\u2019s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you\u2019re done. Sometimes you need a surgical procedure or maybe you don\u2019t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there\u2019s nothing that can cure you, but there\u2019s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn\u2019t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That\u2019s where healthcare is going to ultimately wind up, but we\u2019re not there yet.\nwe are here for you\nFor more information or to schedule an appointment, call (844) 301-4158. You can also schedule an appointment by calling the RCCA location nearest you.\nRELATED ARTICLES\nRegional Cancer Care Associates is one of fewer than 200 medical practices in the country selected to participate in the Oncology Care Model (OCM); a recent Medicare initiative aimed at improving care coordination and access to and quality of care for Medicare beneficiaries undergoing chemotherapy treatment.\n\u00a9 2022 Regional Cancer Care Associates. 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Fight cancer with leading-edge treatments, experienced skill and local caring\/convenience from one of the nation's largest networks of cancer specialists.","email":"info@regionalcancercare.org","mainEntityOfPage":"https:\/\/www.regionalcancercare.org\/","url":"https:\/\/www.regionalcancercare.org\/","sameAs":["https:\/\/twitter.com\/rgnlcancercare","https:\/\/www.facebook.com\/regionalcancercareassoc","https:\/\/www.linkedin.com\/company\/10059183","https:\/\/www.youtube.com\/channel\/UCFlVzU4UvZcyXBCe9ZSvAUQ"],"telephone":"+1 (844) 346-7222","name":"Regional Cancer Care Associates","@id":"https:\/\/www.regionalcancercare.org\/"}],{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"News","item":"https:\/\/www.regionalcancercare.org\/news\/#breadcrumbitem"},{"@type":"ListItem","position":2,"name":"CMS Value Model Doesn’t Do It All","item":"https:\/\/www.regionalcancercare.org\/news\/cms-value-model-doesnt\/#breadcrumbitem"}]}]