CMS Is Watching You: Do You Know Where Your Cancer Patients Are?

With all the buzz that CMS created in the summer of 2016 when it launched its first episode-based payment pilot in oncology, the Oncology Care Model (OCM), it isn’t surprising that most of us totally missed the proposal to add the first oncology performance measure to the Hospital Outpatient Quality Reporting (OQR) Program. The measure, OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy, was 1 of 2 new claims-based measures ultimately included in the 2017 final rule. Its goal is to assess the care provided to cancer patients receiving chemotherapy with the hopes of ultimately reducing the number of unplanned hospitalizations and ED visits.

The fact that CMS has targeted these outcomes specifically is not surprising. In my presentation on oncology “urgent care” from the 2016 Executive Summit series, I highlighted ED utilization and IP hospitalizations as 2 areas proven to reduce overall cancer cost. Case in point, most cancer programs participating in the OCM are focusing on these areas first when trying to reduce cancer costs and ultimately share in the savings.

Data collection for this measure started in January 2018, data reporting to CMS begins next year (2019) and CMS will provide scores in 2020, so now is the time to consider how OP-35 will impact your cancer program.

Most, if not all, programs participating in the OCM are focusing on reducing unnecessary ED utilization and inpatient admissions to reduce costs and ultimately achieve shared savings. However, not every cancer program can readily see the number of ED visits and inpatient admissions within 30 days of chemotherapy at their institution, let alone has visibility into whether their patients visit another ED in the market. To see an example of how Sg2 Analytics tools can provide access to this information and to learn steps to prepare for OP-35 at your institution, check out the full Expert Insight. Not an Sg2 member? Contact us to learn more about strategies for tracking your cancer program’s performance and adapting to performance and quality measures like OP-35.

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