New model makes patient care more than face-to-face visits

 
AMA WIRE Two things that physicians want for their patients are more stability and fewer visits to the emergency department. But often the services that are needed to do so are unbillable, and the resources are hard to find otherwise. A new care model for oncologists intends to solve this problem by providing the resources needed to closely manage patients’ care in-between their face-to-face treatments to reduce complications.

The American Society of Clinical Oncology (ASCO) developed the patient-centered oncology payment model, an alternative payment model (APM) that focuses on two things: making sure the patient is taken care of in a way that prevents complications, which helps them progress toward improved overall health, and ensuring physicians have the necessary resources to provide that quality care.

“The current system is flawed in many ways because it doesn’t pay for the services and the support that patients need and want,” said Robin Zon, MD, an oncologist and member of the ASCO’s Oncology Payment Reform and Implementation Workgroups. “But physicians are paying for it in a number of other ways in order to be able to deliver those services to the patient.”

“What’s happened over time,” she said, “is that practices aren’t able to accommodate those expenses to be able to optimally care of the patient. There are services that the patient is receiving and needs, but they’re non-reimbursable services.”

How the model works

“We developed a system that does three major things,” Dr. Zon said. The model shifts the focus away from typical fee-for-service, holds physicians accountable for high-quality care and makes physicians accountable for only those services they are able to control.

So how does the payment model work, and what kind of difference will it make? Dr. Zon gave an example of a patient we will call John:

  • Before the new model
    Three years ago, before the patient-centered oncology payment model, John would go into a small practice for his chemotherapy. Then he would head home afterwards with instructions to call the office with any concerns or questions. The next day he didn’t feel very good. But he didn’t want to bother the doctor, thinking it was a normal reaction to the chemotherapy or the underlying cancer, so he didn’t call the office. Since this is a small office, there is no extra staff to conduct outbound triage to check on John. Two days later he had severe diarrhea and nausea and ended up so dehydrated that he had to go to the emergency department.

  • After the new model
    Now, John goes into a practice that has implemented the patient-centered oncology model. The next day, an outbound triage nurse calls him at home and asks how he is doing. John says he’s not feeling too great. The nurse says, “Let me talk to the doctor and get back to you.” The nurse calls John again with recommendations from the doctor based on how he is feeling and reeducates him on how to use his supportive care medications.

    The nurse calls again the next day to see if John is feeling any better. John says he’s feeling a little better but not perfect. The nurse responds, “Let me talk to the doctor again.” The next phone call to John includes some adjustments in hydration and diet, as well as recommendations on how to use the supportive medications. In the end, they’re able to help John get through those initial three days, and he never ends up at the hospital.

“The exciting thing about this model is that the focus really is on the patient, which is why I like the name of the model so much,” she said. “It’s patient-centered, meaning the [payment] supports the resources needed to provide the care the patient needs and wants. This is opposed to the current system of [paying] only for face-to-face visits, which does not care for the patient between these encounters.”

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