Understanding Your Patient
…a new column dedicated to easing the administrative burdens on physicians and their staffs
As the shift to value-based reimbursement continues, payers are more and more tying a portion of reimbursement to patient satisfaction scores, measurement of quality of care and the values it brings to the patient and ultimately to the health care system – all of which is requiring physicians and their staffs to place an even greater emphasis on understanding each patient’s unique personal and healthcare needs. Even in the era of savvy younger patients who readily access reliable medical information on the Internet and routinely monitor their own health through medical portals and practice websites, this can be an onerous task for physicians and their staffs.
In the case of older patients, who can be notoriously poor historians, it’s even more of a time-consuming challenge for the physician to fully understand each patient’s personal profile.
For a particular subset of this population, at least, the United States government is offering some much needed help. Dr. Scott Kruger of Virginia Oncology Associates, explains:
“The biggest change that’s happening nationwide is the Oncology Care Model, or OCM project,” Dr. Kruger says. “There are roughly 195 oncology groups participating across the U.S. For the first time, Medicare is giving us access to something they’ve never, ever given any group of doctors before: Medicare claims data.” In short, Medicare is letting these physicians know how many times their patients visit an emergency room or are admitted to the hospital, for whatever reason. “It’s a huge data base that we’ve never seen before,” Dr. Kruger says, “so I’m learning that some of our patients are going to the emergency department for non-oncology related reasons. Now I can look at whether that might have anything to do with our care, or with the medications we’re giving. Unfortunately, unless they tell us specifically, we don’t really know who our patients are seeing, why they’re seeing someone, or what they’re doing.”
Essentially, Medicare wants OCM participants to make an oncology home for these people. They want to work with oncologists to see why patients are going to the hospital, why to the emergency room, and how oncologists can coordinate together with other caregivers to improve quality care. “Medicare is working with us to develop a new model of patient care,” Dr. Kruger says.
There are a host of requirements to participate in the OCM, including ensuring a nurse navigator is available to each patient, and recruiting and training record-keeping personnel. But there too, Medicare is offering financial support.
OCM incorporates a two-part payment system for participating practices, creating incentives to improve the quality of care and furnish enhanced services for beneficiaries who undergo chemotherapy treatment for a cancer diagnosis. The two forms of payment include a per-beneficiary Monthly Enhanced Oncology Services (MEOS) payment for the duration of the episode and the potential for a performance-based payment for episodes of chemotherapy care. The $160 MEOS payment assists participating practices in effectively managing and coordinating care for oncology patients during episodes of care, while the potential for performance-based payment incentivizes practices to lower the total cost of care and improve care for beneficiaries during treatment episodes.
“Now, in addition to knowing the oncology piece of each patient’s care, we have access to information about heart disease, vascular disease, diabetes, and other conditions,” Dr. Kruger says. “This is giving us a much clearer snapshot of who each patient is. And when we understand the whole patient, we can decrease complications in those with major diseases. Knowing what’s going on can help us devise programs to help the patient access the health care system earlier, before complications come up.”
The OCM project has only been in place since July, but Dr. Kruger notes, “I honestly think this is the medicine of the future.”
