Presenters: Alex Khariton, RTT, MBA Becky Schuster, RTT, MHA Gary Webster, MPH
With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the party listed above (and/or spouse/partner) and any for-profit company in the past 24 months which could be considered a conflict of interest. 2
Define The Triple Aim Discuss how cost of care is being evaluated in healthcare (UOS, Action OI) and the alternative payment models in place (or coming soon) Discuss 2016 CMS proposed rules for Radiation Oncology Describe The Cost Calculator Survey and Goals Present the data derived from the survey and the cost calculator tool. Discussion
The Triple Aim concept by Donald Berwick is widely accepted and mentioned in almost every discussion related to value in HC The components of triple aim are Care, Health, and Cost (cost to deliver care or cost to pay for care) Many Oncology professional organizations are creating programs and metrics addressing triple aim concepts For example: Quality Oncology Practice Initiative (QOPI) National Initiative on Cancer Quality (NICCQ) NCCN Quality Measures Professional organizations (ASCO, ASTRO) Choosing wisely campaign Safety is no accident
The healthcare landscape will continue to change rapidly as key initiatives from the Patient Protection and Affordable Care Act (PPACA) take shape and evolve over time Access Health Exchanges Expansion of Medicaid Medicare/Medicaid Dual Eligible Network Development Cost Innovative Payment Delivery Models Focusing on Value, Not Volume Bundled Payments Quality Innovative Care Delivery Models Improved Population Management Emphasis on Prevention and Wellness Integration, Accountability and Risk Sharing One of the greatest challenges that organizations and physicians face today is determining how to move from volume to value in a financially responsible manner.
Value= Quality / Cost
CMS proposes to increase the equipment utilization rate from current standard of 50% to 60% in CY2016 and 70% in CY2017 Mis-Valued Services
Evaluating Cost of Care
Metrics What Metrics Do You Use?? Benchmarks Budget variance reports: real time or post monthly close Department performance vs. other similar organizations Industry and society surveys
With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the party listed above (and/or spouse/partner) and any for-profit company in the past 24 months which could be considered a conflict of interest. 11
To answer questions that very few departments can, such as: What does it cost to treat a patient in your department? How does your department cost per patient compare to industry standards? Identify cost drivers to evaluate and improve efficiency Develop a resource called the Cost Calculator to assist members in evaluating and comparing benchmarks in determining what it costs to provide care
Total costs - all costs incurred in the production of a set quantity of service. Variable costs - those costs which vary with the level of production and are proportional to quantities produced. Overhead In considering health problems, costs may be differentiated as follows: Direct costs - those costs borne by the healthcare system, community and patients' families in addressing the illness. Indirect costs - mainly productivity losses to society caused by the health problem or disease. National Information Center on Health Services Research and Health Care Technology (NICHSR)
Study compared total cost of care for cancer patients based on episode of care in the hospital vs outpatient center. The total episode costs included both plan payments and patient liability (copays / co-insurance) for all services received during the treatment episode. The average chemotherapy episode lasted 3.8 months for patients managed in a physician s office versus 3.4 months for patients managed in a HOPD. For chemotherapy lasting only one month, patients treated in a hospital outpatient setting cost 28 percent more than patients managed in a physician s office. For patients receiving a full 12 months of chemotherapy, hospital outpatient care costs 53 percent more than in the physician office-based setting. For patients receiving radiation therapy, approximately two-thirds of the treatment episodes lasted one or two months and cost approximately 15 percent and 4 percent more, respectively, in a HOPD versus a freestanding location. Approximately one-third of treatment episodes lasted three months and were about 8 percent more expensive in a freestanding location versus the hospital outpatient setting. The average radiation therapy episode lasted 2.1 months for patients managed in a freestanding location versus 1.9 months for patients managed in a HOPD. March 2012 Prepared by Avalere Health, LLC
March 2012 Prepared by Avalere Health, LLC
March 2012 Prepared by Avalere Health, LLC
Abstract Background: To estimate the costs (paid amounts) of palliative radiation episodes of care (REOCs) to the bone for patients with bone metastases secondary to breast or prostate cancer. Methods: Claims-linked medical records from patients at 98 cancer treatment centers in 16 US states were analyzed. Inclusion criteria included a primary neoplasm of breast or prostate cancer with a secondary neoplasm of bone metastases; 2 visits to 1 radiation center during the study period (1 July 2008 through 31 December 2009) on or after the metastatic cancer diagnosis date; radiation therapy to 1 bone site; and 1 complete REOC as evidenced by a >30-day gap pre- and post-radiation therapy. Results: The total number of REOCs was 220 for 207 breast cancer patients and 233 for 213 prostate cancer patients. In the main analysis (which excluded records with unpopulated costs) the median number of fractions per a REOC for treatment of metastases was 10. Mean total radiation costs (i.e., radiation direct cost + cost of radiation-related procedures and visits) per REOC were $7457 for patients with breast cancer and $7553 for patients with prostate cancer. Results were consistent in sensitivity analyses excluding patients with unpopulated costs. Conclusions: In the US, current use of radiation therapy for bone metastases is relatively costly and the use of multi-fraction schedules remains prevalent. Gregory Hess1,2*, Arie Barlev3, Karen Chung3, Jerrold W Hill1 and Eileen Fonseca1
Gregory Hess1,2*, Arie Barlev3, Karen Chung3, Jerrold W Hill1 and Eileen Fonseca1
With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the party listed above (and/or spouse/partner) and any for-profit company in the past 24 months which could be considered a conflict of interest. 19
https://home.clearcosthealth.com/ http://mobihealthnews.com/29400/8- companies-working-on-price-transparency/
Designed to set a range for per patient cost benchmark R&E decided to create a tool cost calculator to understand the cost for radiation oncology department per patient Evaluate components and drivers of cost in comparison to other departments based on case mix complexity, staffing models, and other factors
Facility type (Hospital or Free standing Center) What s included in the operating budget: ( Rent, physics expense, radiopharmaceuticals) Technology Department statistics and case mix Staff mix Finical data: Patient Volumes Operating Expense Operating Revenue
14 participants (30% survey response rate) 9 Hospital (5 Academic) and 5 Free standing departments Data collected for 2012, 2013 and 2014 to evaluate trends Variations: - Biomedical services - Physics services - Radiopharmaceuticals - Rent and facility cost - Capital and lease expenses for equipment
Physics (contracted/university staff) Average department 2014 2.5 Linacs HDR Tx planning IMRT % 38% SRS/SBRT 15% 75% have 2-3 systems Per 1 FTE ACR July 2015 Staffing: MD 3 185.0 204 NP 1.7 326.5 RTT 7.9 70.3 76 RN/LPN 4 138.8 Dosimetrists 3 185.0 270 Billing staff 2.7 205.6 Office staff 5.26 105.5 Managers 2 277.5 Total staff: 29.56 RTT per Linac 3.16 3.7 Patient per Linac 222 209 Physics 1-1 with Oncologist 185.00 260
Average Pt. volume 2012 2013 2014 Total number of Pt treated 520 520 555 IMRT Pt 177 193 210 SRS/SBRT Pt 62 75 81 HDR Pt 32 31 32
Dramatic decrease in treatments per patient
Average cost per patient. Blended Hospital and free standing facility.
Rent, physics, service contracts are included in the free standing facility numbers.
The % overhead for Free standing and hospital facilities will be different
Dramatic differences in reimbursement per case. Blended reimbursement for TC and global providers.
Survey results gave us good directional data. Additional data needed to improve the tool and make it more useful. Our goal is to make the tool available and collect additional data to confirm original results and grow the database.
Jeff Buckman Joy Godby Alex Khariton Brenda Marie Palo Becky Schuster Kim Sevening Gary Webster buckmanj@upstate.edu ajgodby@mdanderson.org alex.khariton@jefferson.edu mpalo@ucdavis.edu becky.schuster@mckesson.com kim@hopegroupllc.com gary.webster@hci.utah.edu