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Am J Manag Care. 2018 Dec;24(12):618-623.
This study seeks to identify service categories that present the greatest opportunities to reduce spending in oncology care episodes, as defined by the CMS Oncology Care Model (OCM). Regional variation in spending for similar patients is often interpreted as evidence that resources can be saved, because higher-spending regions could achieve savings by behaving more like their lower-spending counterparts.
We used Surveillance, Epidemiology, and End Results Medicare data from 2006-2013 for this retrospective observational cohort study. Analysis focused on patients with non-small cell lung cancer, advanced (stage III or IV) breast cancer, renal cell carcinoma, multiple myeloma, or chronic myeloid leukemia.
Episodes were identified for patients with the 5 included cancers, following the episode definition used in the OCM. We estimated standardized episode-level spending for a standard patient across subcategories of care for each hospital referral region (HRR) defined by the Dartmouth Atlas. The contribution of each subcategory to interregional variation in total spending reflects that subcategory's potential to yield savings.
Chemotherapy and acute inpatient hospital care tended to be the highest contributors to interregional variation. Imaging, nonchemotherapy Part B drugs, physician evaluation and management services, and diagnostics were negligible contributors to interregional variation for all 5 cancers.
Chemotherapy and inpatient hospital care offer the most potential to reduce spending within OCM-defined episodes. Other sources of savings differ by type of cancer. Assuming patient outcomes are not compromised, low-spending HRRs may be models for lowering cost in cancer care.
本研究旨在确定 CMS 肿瘤学护理模式（OCM）定义的肿瘤学护理事件中最有潜力降低支出的服务类别。通常，对类似患者的支出存在地区差异，被解释为可以节省资源的证据，因为高支出地区可以通过更像低支出地区那样的行为来实现节省。
我们使用了 2006-2013 年的监测、流行病学和最终结果 Medicare 数据进行这项回顾性观察队列研究。分析集中在患有非小细胞肺癌、晚期（III 期或 IV 期）乳腺癌、肾细胞癌、多发性骨髓瘤或慢性髓性白血病的患者上。
根据 OCM 中使用的事件定义，为患有 5 种纳入癌症的患者确定了事件。我们估计了每个 Dartmouth 图谱定义的医院转介区域（HRR）中每个护理亚类的标准患者的标准化事件级别支出。每个亚类对总支出地区间差异的贡献反映了该亚类节省的潜力。
化疗和急性住院医院护理往往是地区间差异的最大贡献者。对于所有 5 种癌症，成像、非化疗 B 部分药物、医师评估和管理服务以及诊断在地区间差异中几乎没有贡献。
在 OCM 定义的事件中，化疗和住院医院护理提供了最大的降低支出潜力。其他节省来源因癌症类型而异。假设患者的结果不受影响，低支出 HRR 可能是降低癌症护理成本的模型。
