Robert Baird Jr., RN, MSA
The rollout of the Oncology Care Model (OCM) from CMS has proven to be a challenging road, specifically involving technological challenges, as practices have scrambled to find seamless solutions to bridging old electronic health records (EHR) with new "patches" designed for the OCM. Moreover, it has involved coaxing oft-reluctant staff members to adapt to new ways of performing.
During a presentation titled "Lessons Learned" at the 2017 Community Oncology Alliance (COA) Annual Meeting, panelists stated these difficulties were not insurmountable, in reflections on the first year of the OCM.
The conference discussion featured Robert Baird Jr., RN, MSA, chief executive officer of Dayton Physicians Network, in Dayton, Ohio, as moderator. The participating practice administrators were Anne Marie Rainey, MSN, RN, CHC, compliance and control officer with Clearview Cancer Institute, in Huntsville, Alabama; and Alti Rahman, MHA, practice administrator for Oncology Consultants in Houston, Texas.
OCM requirements for greater reporting, performance measures, and more extensive patient care plans were reviewed, and Rahman and Rainey described how they addressed each of these and what obstacles had to be overcome.
Rainey described her practice’s experience with the OCM as a sometimes frustrating process of trying to conform to the new expectations for patient-centered care.
“Some days you feel that you have it really well figured out,” she said. “You’re getting the care plans together, things are going well in the clinic. We feel like employees understand this shift from fee-for-service to value-based care and what that means, and then there are other days when we feel like we are pulling our hair out—that we’ve missed the boat on some of these items.”
Rainey’s clinic has 3 full service locations and 2 satellite locations with limited office visits, 1 day a week. They have 12 doctors and 16 mid-level providers. They also do retail pharmacy and lab work in-house, as well as imaging and genomic testing. They also do radiation and physical therapy at their main location.
Rahman’s practice has 19 providers, including 15 physicians and 4 mid-level providers, working from 9 medical oncology locations and 2 radiation centers. They do oral pharmacy, research, and imaging in-house.
Rainey said there are many elements to the OCM that have had a very positive impact on the way patient care is delivered, but she said many requirements have been difficult to integrate smoothly with standard operations. “Even though there are going to be road bumps along the way, we’re really trying hard to make changes in our practice that are going to be sustainable. That’s true not just for our practice but for the future of oncology care,” she said.
Rahman agreed with that statement, indicating that a good measure of the complexity of a task is the number of gray hairs it produces, and that the OCM has given him a wide swath of gray hair.
Both speakers said their practices had to improve internal communications to make the transformation a success. Staff members had to cross-check one another’s progress toward meeting the OCM goals. Without that key activity, progress was liable to move sluggishly.
Certain members embraced the OCM from the start. Rahman said a successful division of labor into 2 teams—1 of which looked at operational aspects of the practice, clinical and nonclinical, and the other, operations—created a counterbalancing force that kept everybody moving forward.
These teams communicated with each other “to make sure that whatever operational processes were being created always led to appropriate reporting. I think that’s helped us to organize the OCM and loop in other quality initiatives instead of having separate work groups that address things more on a project-specific basis,” Rahman said. He said practice administrators sought to create an understanding that the OCM transformation was important, not just for their operations, but for the practice of oncology in general.
Rainey said that in her practice they realized that e-mails weren’t checked regularly by staff, so they held team meetings more often to provide continuous quality feedback on OCM progress. In addition, Rainey visited clinical staff members more regularly to discuss performance and potential improvements. “I also [established] an open-door policy so that people could come in and say, ‘Today was really bad. I didn’t get a care plan done for any of my patients.’” Together they could do joint assessments and arrive at solutions, she said.