Barbara McAneny MD CEO, CEO New Mexico Cancer Center CEO, Innovative Oncology Business Solutions AMA Board of Trustees

Transcription

1 Barbara McAneny MD CEO, CEO New Mexico Cancer Center CEO, Innovative Oncology Business Solutions AMA Board of Trustees

2 The project described is supported by Funding Opportunity Number CMS-ICI from Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation The content of the presentation are solely the responsibility of the authors and do not necessarily represent the official views of HHS or of any of its agencies.

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5 Chart #12

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10 Medicare payment vs. practice cost inflation

11 62.1% of Bankruptcies are from Medical bills : 48% of the bills are from Hospitals, 18% drugs, 15% physicians Annual Health Care Costs $16,771

12 When patients visit a physician office that is part of a hospital s outpatient department, Medicare pays a facility fee to the hospital and a reduced fee for the physician s services. The combined fees paid for visits to hospital based practices are often more than 50 percent greater than rates paid to freestanding practices.

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14 Physician fee schedule payments: $47,500 Hospital Outpatient Prospective Payment System: $54,000 Milliman Client Report Oct 19, 2011 by Fitch and Pyenson

15 A detailed analysis of the demonstration is currently available only for the first two years. That analysis showed that, for patients in the 10 group practices during the second year, average Medicare spending excluding the bonuses paid to physician groups was about 1 percent below projections; with bonuses included, average Medicare spending was just 0.1 percent below projections about $7 per beneficiary.

16 Focus on the patients with expensive illnesses What factors can doctors control? What data do we need to prevent complications?

17 CMMI 1 Support for Oncology Medical Homes Innovative Oncology Business Solutions COME HOME 2 Project Development of Medical Home New Mexico Cancer Center care delivery model matches medical home Payer Engagement Unsuccessful One local and one national payer approached, unwilling to create new payment model Application for CMS Health Care Innovation Award CEO of NMCC forms the consulting group Innovative Oncology Business Solutions 4 COME HOME Project Spreading the Oncology Medical Home Grant will support care transformation at seven oncology practices, potentially providing a proof of case net.orange Partnership Health care informatics company will create electronic dashboards to monitor pathway adherence, share blinded data with providers, and compile data useful for the creation of bundled payments 1) Center for Medicare and Medicaid Innovation. 2) Community oncology medical home. 17 Source: Innovative Oncology Business Solutions, Albuquerque, NM; Oncology Roundtable interviews and analysis.

18 Study Patient Types ED Visits IP Adm Group Health Coop of Puget Sound (12 mos) All Pts -29 % -11 % Community Care of North Carolina Asthma -16 % - 40% Health Partners Medical Group BestCare Patient Centered Medical Home (PCMH) (5 Yrs) All Pts -39 % -24 % Genessee Health Plan HealthWorks PCMH (4 yrs) All Pts - 50% -15 % Johns Hopkins Guided Care (12 mos) Geisenger Health System ProvenHealth Navigator Chronic Disease Chronic Disease -15 % -24 % % Intermountain Healthcare Medical Group PCMH All Pts %

19 Triage Nurses Triage system Same day appointments Ability to function as urgent care (lab, Xray) Extended hours (without the volume to support) Patient education Doctors on call admitting their own patients Pathway development

20 Direct admissions (no ED) $196,200 Clinic instead of ED visits $1,208,700 Hospice instead of Hospital $3,900,000 Lower ALOS $2,125,500 Avoided Admissions $18,500,040

21 Innovative Oncology Business Solutions (IOBS) managing organization formed for the purposes of administering project Seven community oncology practices New Mexico Cancer Center Center for Cancer & Blood Disorders (Ft. Worth) Dayton Physician Network (OH) Space Coast Oncology Maine Center for Cancer Medicine NW Georgia Oncology Centers Austin Oncology Group Net.Orange HIT company creating customized quality & pathway performance dashboards using claims data and integrated EHRs KEW Group integration of genetic markers into diagnostic and therapeutic pathways UTHSC evaluation, cost, quality measurement expertise; using claims data for rapid-cycle feedback of cost/utilization performance

22 Newly diagnosed or relapsed oncology patients Seven tumor types will be put on Diagnostic/ Therapeutic Pathways: Breast Lung Colorectal Lymphoma Melanoma Pancreas Thyroid Seeking 1 of 7 participating sites

23 Enhanced Services (Phase I) Patient education & medication management 24/7 practice access: telephone triage, triage pathways, night/weekend clinic hours, on-call physicians On-site or near-site imaging, lab testing Admitting physicians who shepherd pts through IP encounters, avoiding handoffs & readmits, ensure seamless care Diagnostic pathways, including genetic markers (Phase II) Therapeutic pathways, including genetic markers (Phase III)

24 Patient Type Medicare Non-Medicare Total Breast Cancer 1, ,891 Lung Cancer 1, ,830 Colorectal Cancer ,058 Lymphoma Melanoma Pancreas Thyroid Other Cancers 2, ,961 Total Cases 8,022 1,536 9,558

25 Service Average Cost Per Unit of Service Baseline Total Costs Per Patient* Projected Decrease in Costs Projected Total Costs Per Patient Projected Average Savings Per Patient Hospital $8,225 $17, % $13,489 $3,619 ED Visits $ 554 $ 1, % $543 $ 593 Physician $ 228 $ 6, % $6,882 - $ 484 Pharmacy $ 90 $13, % $12,905 $ 450 Other $9,480 $28, % $28,573 $ 0 Total $66, % $62,391 $4,178 *Cost Projections based on Medical Expenditure Panel Survey (MEPS) data for Medicare beneficiaries in poor health, inflated to reflect higher expenditures associated with cancer.

26 Wish me luck. Any questions?