Alexander Hantel, MD
At Edward Cancer Center in the affluent Chicago suburbs, patients generally have good insurance, donors have contributed millions of dollars to capital campaigns, and sophisticated services like multi-disciplinary care coordination and patient navigators are supported by the center’s parent hospital.
Yet despite its healthy finances, Edward is eagerly hoping to be selected to participate in the Centers for Medicare & Medicaid Services’ new Oncology Care Model (OCM), a pilot program that will require the cancer center to measurably cut costs even as it beefs up its services and analytical capabilities.
“We've always worked in a situation where our only concern has been the care of the patient, which is fine. That's the way it should be,” said Alexander Hantel, MD, the center’s director of medical oncology. “But at the same time we also are realizing as physicians that the value of what we prescribe for patients has to be more carefully assessed.”
The push for greater efficiency comes at a time of growth for the center, which was established a decade ago when Edward Hospital in Naperville, Illinois brought its visiting oncologists onto its staff. A second site opened nearby in Plainfield in 2009. From 2005, when the center treated 1135 cases, volume at the two sites grew to 1386 in 2011 and to 1850 last year, said administrative director Jenna VanGilder.
The center has 7 medical oncologists, 4 radiation oncologists, 2 surgical oncologists and 7 advanced practice nurses. A third surgical oncologist is coming on in August.
Hantel said he wants to join the Oncology Care Model to address the ever-increasing cost of cancer drugs, or at least to help CMS assess the merits of a new approach. VanGilder said participating would give Edward the jump on cost-containment mandates that all oncology practices could be forced to adopt a few years from now.
“There's obviously some scary things about the model that we know that we don't do that great, but we also realize that we probably should. So why not learn along the way and figure it out now, rather than wait?” she said.
Despite its money-saving potential, the Oncology Care Model has taken some criticism for preserving traditional fee-for-service (FFS), tying incentive payments to factors the oncologist does not control, and for paying according to “arbitrary” 6-month treatment episodes.1 ASCO’s preferred alternative, called Consolidated Payments for Oncology, would depart from FFS by switching to relatively large payments at the start of treatment and every month, as well as payments during treatment holidays and after treatment ends.2 Pay would be cut for practices that don’t follow guidelines for prevention of complications, end-of-life care, and use of drugs, testing and imaging.
Edward, however, has embraced the OCM. In addition to moving to the edge of payment reform, Edward would benefit from the model’s $160 monthly per-patient fee, which is intended to cover coordinated care and other improvements in treatment of chemotherapy patients, VanGilder said.
“We offer a lot of these things already, and we're not getting the extra per-beneficiary payment per month. We do provide a lot of that care coordination,” she said. “Not that we're going to make money by any means, but to get some reimbursement to assist with these resources would be nice.”
The care coordination comes via specialized clinics for lung, brain, breast, gastrointestinal and genitourinary cancer. The lung clinic, for example, has a dedicated surgeon, medical oncologist, radiation oncologist, pathologist, radiologist, and psychosocial and research staffers, VanGilder said. The physicians meet weekly to discuss cases and plan treatment, and an advanced practice nurse arranges appointments and shepherds the patient through.
The cancer center and Edward Hospital have also been on the forefront of meeting quality standards of the type required by the Oncology Care Model, Hantel said. They include ASCO’s Quality Oncology Practice Initiative Certification.
“We're probably a relatively high cost practice just because we are in a high-reimbursement and high-utilization region of the country. But at the same time, we have always done all of the quality improvement measures,” he said. “We're way ahead of the curve in terms of really trying to give good quality care and do it in a measurable way in our practice. So we have every certification you could think of.”
Hantel said his only major concern about the OCM relates to the long-term sustainability of the model’s incentive scheme.