CMS Claims Data Provide Glimpse of True Cost Picture

Meir Rinde
Published: Friday, Oct 27, 2017
Sarah Cevallos
Sarah Cevallos
Since March, practices in the CMS Oncology Care Model (OCM) have been receiving giant data dumps every 3 months containing all their patients’ recent Medicare claims. The spreadsheets cover every provider the patients have visited during their cancer treatment. As the OCM practices work to reduce Medicare’s overall spending on those patients and to earn shared savings payments, the data are providing them with an unprecedented full picture of the extent and cost of care.

 

Figure 1. Practices Have Used CMS Data to Calculate Total Costs of Care

CMS Data to Calculate Total Costs of Care

Figure 2. Oncology Care Model Practices Track Inpatient Admission Rates by Physician

Oncology Care Model Practices
For many practices, the data feed confirmed that steps they had already taken, such as encouraging patients to call in when they feel nauseated or dehydrated, had already reduced emergency department (ED) visits and hospitalizations. In some places, managers quickly noticed high costs or overuse of services at outside providers, pointing them toward ways to further reduce spending.
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