美国Abt Associates公司Andrea Hassol联合哈佛医学院Nancy L. Keating团队研究了参与肿瘤护理模式与医疗保险支付、利用、护理提供和质量结果的相关性。该研究于2021年11月9日发表在《美国医学会杂志》上。

2016年，美国医疗保险和医疗补助服务中心启动了肿瘤护理模式（OCM），这是一种替代支付模式，旨在提高患有癌症的医疗保险受益人的护理价值。

为了评估OCM与医疗保险支出、利用率、质量和患者体验变化的关系，研究组进行了一项探索性差异研究，比较了在OCM开始之前（2014年1月至2015年6月）和之后（2016年7月至2018年12月）的OCM参与实践中6个月化疗期间的护理和倾向匹配比较实践。参与者包括截至2019年6月在这些诊所接受癌症治疗的医疗保险收费服务受益人。

主要观察指标为总分段费用（A、B和D部分的医疗保险支出，不包括强化肿瘤服务的每月付款）；住院、急诊（ED）就诊、诊室就医、化疗、支持性护理和成像的使用和付款；质量（化疗相关住院和急诊就诊、及时化疗、临终关怀和生存率）；和病人的体验。

在接受化疗的癌症患者医疗保险服务受益人中，201个OCM参与实践包括483319名受益人（平均年龄为73.0岁；60.1%为女性；共治疗987332阶段），534个对照实践包括557354名受益人（平均年龄为72.9岁；57.4%为女性；共治疗1122597阶段）。

从基线期开始，总分段费用从OCM阶段28681美元、对照阶段28421美元，增长至干预期间OCM阶段33211美元、对照阶段33249美元，低于平均每月704美元的肿瘤强化服务费用。总分段付款的相对减少主要是B部分非化疗药物付款，尤其是支持性护理药物。

OCM与高风险事件中总分段费用的统计显著相对减少和低风险事件中总分段费用的统计显著相对增加相关。OCM与住院、急诊就诊或生存率的差异无显著相关性。在22项利用率指标、10项质量指标和7项护理体验指标中，只有5项存在显著差异。

研究结果表明，在这项探索性分析中，OCM与在OCM的前3年接受癌症化疗的医疗保险受益人在6个月期间的中度付款减少显著相关，这并没有抵消强化肿瘤服务的每月付款。大多数利用率、质量和患者体验结果在统计学上没有显著差异。

附：英文原文

Title: Association of Participation in the Oncology Care Model With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes

Author: Nancy L. Keating, Shalini Jhatakia, Gabriel A. Brooks, Amanda S. Tripp, Inna Cintina, Mary Beth Landrum, Qing Zheng, Thomas J. Christian, Roberta Glass, Van Doren Hsu, Colleen M. Kummet, Susannah Woodman, Carol Simon, Andrea Hassol, Oncology Care Model Evaluation Team, Giulia Norton, Sean McClellan, Jessie Gerteis, Maria Alice Manetas, Nathan West, Andrew Evans, Mary Juergens, Stephanie Shao, Nirav S. Kapedia, Lauren Riedel, Michael P-H Liu, Robert Wolf, Hajime Uno, Madison Davidson, Rebecca Acanfora, Nwannamaka Ume, David Zhang, Dylan Davis, Anna Braendle, Sehreen Khan, Chai Wong, Sebastian Negrusa

Issue&Volume: 2021/11/09

Abstract:

Importance  In 2016, the US Centers for Medicare & Medicaid Services initiated the Oncology Care Model (OCM), an alternative payment model designed to improve the value of care delivered to Medicare beneficiaries with cancer.

Objective  To assess the association of the OCM with changes in Medicare spending, utilization, quality, and patient experience during the OCM’s first 3 years.

Design, Setting, and Participants  Exploratory difference-in-differences study comparing care during 6-month chemotherapy episodes in OCM participating practices and propensity-matched comparison practices initiated before (January 2014 through June 2015) and after (July 2016 through December 2018) the start of the OCM. Participants included Medicare fee-for-service beneficiaries with cancer treated at these practices through June 2019.

Exposures  OCM participation.

Main Outcomes and Measures  Total episode payments (Medicare spending for Parts A, B, and D, not including monthly payments for enhanced oncology services); utilization and payments for hospitalizations, emergency department (ED) visits, office visits, chemotherapy, supportive care, and imaging; quality (chemotherapy-associated hospitalizations and ED visits, timely chemotherapy, end-of-life care, and survival); and patient experiences.

Results  Among Medicare fee-for-service beneficiaries with cancer undergoing chemotherapy, 483319 beneficiaries (mean age, 73.0 [SD, 8.7] years; 60.1% women; 987332 episodes) were treated at 201 OCM participating practices, and 557354 beneficiaries (mean age, 72.9 [SD, 9.0] years; 57.4% women; 1122597 episodes) were treated at 534 comparison practices. From the baseline period, total episode payments increased from $28681 for OCM episodes and $28421 for comparison episodes to $33211 for OCM episodes and $33249 for comparison episodes during the intervention period (difference in differences, $297; 90% CI, $504 to $91), less than the mean $704 Monthly Enhanced Oncology Services payments. Relative decreases in total episode payments were primarily for Part B nonchemotherapy drug payments (difference in differences, $145; 90% CI, $218 to $72), especially supportive care drugs (difference in differences, $150; 90% CI, $216 to $84). The OCM was associated with statistically significant relative reductions in total episode payments among higher-risk episodes (difference in differences, $503; 90% CI, $802 to $204) and statistically significant relative increases in total episode payments among lower-risk episodes (difference in differences, $151; 90% CI, $39-$264). The OCM was not significantly associated with differences in hospitalizations, ED visits, or survival. Of 22 measures of utilization, 10 measures of quality, and 7 measures of care experiences, only 5 were significantly different.

Conclusions and Relevance  In this exploratory analysis, the OCM was significantly associated with modest payment reductions during 6-month episodes for Medicare beneficiaries receiving chemotherapy for cancer in the first 3 years of the OCM that did not offset the monthly payments for enhanced oncology services. There were no statistically significant differences for most utilization, quality, and patient experience outcomes.

DOI: 10.1001/jama.2021.17642

Source: https://jamanetwork.com/journals/jama/article-abstract/2785949