Alti Rahman, MHA, MBA, CSSBB
There is a lack of hard data on practice performance that makes it difficult to understand where to make improvements so that goals under the Oncology Care Model (OCM) can be reached, 2 administrators told a recent audience of oncology professionals. However, with the information that is available, it is possible to achieve positive changes and even a spirit of friendly competition, they said.
“We have seen very meaningful changes,” said Alti Rahman, MHA, MBA, CSSBB, practice administrator for Oncology Consultants of Houston, who described having instituted monthly staff meetings at which CMS data regarding practice performance on OCM quality measures was discussed. Wherever results could be measured it has been possible to make headway. “The areas that we’ve struggled with are the areas that we’ve had difficulty reporting on,” he said.
Rahman shared the podium with Anne Marie Rainey, MSN, RN, CHC, compliance and control officer for the Clearview Cancer Institute of Huntsville, Alabama, at the 2017 Community Oncology Conference for the Community Oncology Alliance. Already, the OCM has injected more clinical value and efficiency into practice activities, Rahman and Rainey agreed. Care has become more patient-centered as their practices have broadened mental health and advanced care initiatives. Interdepartmental communications also have improved, and unnecessary use of hospital and emergency departments (EDs) has been reduced.
Earlier this year, CMS released what practices have described as an extremely useful cache of information about claims data, not just from their own clinics, but from their market area. This has enabled practices to understand much more about what is going on with their patients. Rahman said practices are hungry for more of this data and would like CMS to provide regular installments. “We’ve had an iteration of it, and we need more.”
Despite its usefulness, the mass of data needs to be scrutinized and picked apart carefully to arrive at meaningful insights that could actually point to ways a practice could improve its operations, Rahman said. “Even though you have 10 patients admitted to a certain hospital at a rate of $50,000 each and another hospital has 5 patients at a rate of $500,000, that’s still a very surface-level view.” Rahman’s practice has partnered with analytics companies to help with the job of interpretation.
Reporting data to CMS also has been a challenge for practices. They have had to employ new software and synchronize that with established practice management systems that often “don’t play nice” with other technology, Rainey said. Sometimes a software system will deliver an unexpected benefit, however. For Rainey’s practice, the capabilities of a patient portal system enabled her to review patient lists and spot information gaps that wouldn’t have been acceptable to CMS. “You never know what to expect the first time you go to submit that quality data. It was a really big deal for us, just knowing that that system worked. We were able to validate the data and submit it relatively easily,” she explained.
Administrators at Rainey’s and Rahman’s practices were hesitant to go out and acquire new software management systems to help with the OCM transition. “There was so much change already going on. I cannot imagine starting the OCM and trying to change the system at the same time. That would be very stressful,” Rainey said. It was better to find a “middle ground” between old and new than start out afresh with all-new software, Rahman added.
Better Results on Advanced Care Directives
Completion of advanced care directives became a prime target for improvement at Rainey’s clinic. Practice administrators knew already that this element of patient-centered care had been deficient because staff often felt uncomfortable discussing these issues with patients. They also recognized this as an area in which they could make definite and measurable improvements.
Previously, “Only about 1.5% of our patients had a DNR (do not resuscitate) status documented in a structured field in our electronic medical record,” Rainey said. “I’m really proud to say that we now have about 75% to 76% of our Medicare patients consistently documented. That’s just one area where it’s really opened the door for us to have to ask patients about something that maybe is uncomfortable for the staff member.”