Sameer Mahesh, MD, is a hematologist-oncologist with Summa Health Cancer Institute and Principal Investigator of the Oncology Care Model at Summa Health.
According to the NIH, Americans over 65 account for 60% of newly diagnosed cancers each year. In an effort to provide higher quality, better coordinated oncology care for this medically complex population, CMS created the Oncology Care Model (OCM). Under this 5-year program, which began in July 2016, physician group practices enter into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients.
Summa Health Medical Group – Oncology is one of 190 group practices in the nation accepted into the OCM program. Sameer Mahesh, MD, is a hematologist-oncologist with Summa Health Cancer Institute and Principal Investigator of OCM at Summa Health.
“Approximately 500 practices applied for the OCM grant, and 190 practices were accepted,” Dr. Mahesh explains. “We are the only group in the Akron/Canton region, and one of only 12 in Ohio, to have received and implemented this grant.”
No doubt, Summa Health’s cancer program’s accreditation by the American College of Surgeons Commission on Cancer (CoC) was a key in obtaining this grant. Summa’s cancer program is also accredited by the American College of Radiology (ACR) for radiation oncology and for breast imaging. In addition, it meets quality measures for medical oncology from the American Society of Clinical Oncology’s Quality Oncology Practice Initiative (QOPI), which promotes excellence in cancer care by helping oncology practices create a culture of self-examination and improvement.
Summa Health is also a member of NRG Oncology, a non-profit research organization formed to conduct oncologic clinical research and to broadly disseminate study results for informing clinical decision making and healthcare policy.
The CMS Oncology Care Model focuses on Medicare fee-for-service (FFS) beneficiaries receiving chemotherapy treatment. OCM includes the entire spectrum of care provided to a patient during a six-month episode that begins with chemotherapy, including:
- The core functions of patient navigation;
- A care plan that contains the 13 components in the Institute of Medicine Care Management Plan outlined in the Institute of Medicine report, “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis”;
- Patient access 24 hours a day, 7 days a week to an appropriate clinician who has real-time access to practice’s medical records; and
- Treatment with therapies consistent with nationally recognized clinical guidelines.
OCM participants must also drive continuous quality improvement through the use of data and certified electronic health record technology.
“This program takes care of comprehensive needs of the cancer patient,” says Dr. Mahesh. “And because advanced care planning is a requirement, patients get a chance to plan ahead. In addition, access to financial counselors, behavioral health, social work and palliative care is critical. This doesn’t differ from the way our team practices in principle, but it has differed in the aspect of implementation. We are more pro-active than re-active and, as a result, patients are benefiting.”
Summa Health Cancer Institute’s OCM team includes medical oncologists, surgeons, psychologists, palliative care, advanced nurses and a specialized support staff. All members of the team work together to support patients and their families and caregivers.
“We have staff that has been delegated to this program, and we have made all the practice transformations, so that individualized patient care is more systematic. It’s more thorough,” says Dr. Mahesh. “CMS gives us quarterly feedback reports, so now we are actually measuring and seeing our results. And if there are any deficits, we’re addressing the need to improve that.”
Shown here are members of Summa Health Cancer Institute’s OCM team. Standing (L to R) are Sameer Mahesh, MD, Oncologist and Principal Investigator OCM; Joseph Koenig, MD, Oncologist and Medical Director, Cooper Cancer Center at Summa Health System – Akron Campus; Elise Longfellow, RN, OCM Program Manager; Patrice Peters, MA, Summa Health Breast Center; and Kelly Sapola, Medical Office Coordinator, Summa Health Breast Center. Seated (L to R) are Mindi Reinbolt, Practice Manager, Medical Oncology; Ashley Wyatt, CNP, Palliative Care Nurse Practitioner; Leslie Pfaff, Oncology Patient Financial Advocate; and Jenna Massoli, RN, BSN, Medical Oncology Nurse Navigator.
CMS utilizes clinical data and quality measures as a key mechanism to verify clinical improvements, assess patient health outcomes and appropriate coordination of care, and ensure continued quality of care for Medicare beneficiaries. Participant performance is tracked by CMS on multiple quality domains using patient- and practice-reported measures as well as claims-based measures.
OCM quality measures were selected by CMS across four of the National Quality Strategy Domains, including communication and care coordination, person and caregiver-centered experience and outcomes, clinical quality of care, and patient safety. In addition, the model utilizes 12 quality measures in the calculation of participants’ performance-based payments.
To date, Summa Health’s OCM team has received two quarterly reports. The data, from cancer care provided in 2016, indicates that Summa’s cancer care is equal in outcomes to other large tertiary care centers in the country – and at a lower cost to Medicare.
“And equally importantly, what we are seeing is that a large number of our patients, as compared to other practices’ patients, are spending less time in the hospital in the last 30-90 days of life,” says Dr. Mahesh. “They are getting less chemotherapy and fewer ICU stays in their last 30 days of life. And they are spending more time in hospice at home, where they want to be. That’s what the CMS report shows.”
He points out that these practice transformation activities are not limited to Medicare beneficiaries. The benefit is for all patients regardless of payer.
“The goal is to provide high quality comprehensive care with equal or better outcomes and potentially lower costs to everyone,” Dr. Mahesh explains. “And that’s what Summa’s Oncology Care Model does.”
For more information about Summa Health Cancer Institute, visit summahealth.org/cancer. To refer a patient, call 234-312-5615.