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Am J Manag Care. 2023 May 1;29(5):e136-e142. doi: 10.37765/ajmc.2023.89338.
New and emerging therapies have significantly changed the bladder cancer (BC) treatment landscape and can potentially affect spending and patient care in CMS' Oncology Care Model (OCM), a service delivery and payment model for voluntarily participating practices. The objectives of this analysis were to estimate health care resource utilization (HCRU) and benchmark spending per OCM episode of BC, and to model spending drivers and quality metrics.
Retrospective cohort study.
A retrospective cohort study was conducted of OCM episodes triggered by receipt of anticancer therapy among Medicare beneficiaries from 2016 to 2018. Based on this, an average performance estimation was conducted to assess the impact of hypothetical changes in novel therapy use by OCM practices.
BC accounted for approximately 3% (n = 60,099) of identified OCM episodes. Relative to low-risk episodes, high-risk episodes were associated with greater HCRU and worse OCM quality metrics. Mean spending per high-risk episode was $37,857 (low-risk episode: $9204), with $11,051 spent on systemic therapies and $7158 on inpatient services. In the estimation, high- and low-risk BC exceeded the spending target by 1.7% and 9.4%, respectively. This did not affect payments to practices and no retrospective payments were necessary.
As 3% of OCM episodes were attributed to BC, with only one-third classified as high-risk, controlling expenditure on novel therapies for advanced BC is unlikely to affect overall practice performance. The average performance estimation further emphasized the minimal impact that novel therapy spending in high-risk BC has on OCM payments to practices.
新出现的治疗方法显著改变了膀胱癌（BC）的治疗格局，可能会影响 CMS 肿瘤学护理模式（OCM）中参与自愿实践的医疗机构的服务提供和支付模式的支出和患者护理。本分析的目的是估计膀胱癌 OCM 发作的医疗资源利用（HCRU）和基准支出，并对支出驱动因素和质量指标进行建模。
回顾性队列研究。
对 2016 年至 2018 年接受抗癌治疗的 Medicare 受益人的 OCM 发作进行回顾性队列研究。在此基础上进行平均绩效估计，以评估 OCM 实践中新型治疗方法使用变化的影响。
BC 约占确定的 OCM 发作的 3%（n=60099）。与低危发作相比，高危发作与更高的 HCRU 和更差的 OCM 质量指标相关。高危发作的平均支出为 37857 美元（低危发作：9204 美元），其中 11051 美元用于系统治疗，7158 美元用于住院服务。在估计中，高危和低危 BC 分别超出支出目标 1.7%和 9.4%。这不会影响对实践的支付，也不需要进行回溯性支付。
由于 OCM 发作的 3%归因于 BC，只有三分之一被归类为高危，控制晚期 BC 新型治疗方法的支出不太可能影响整体实践绩效。平均绩效估计进一步强调了高危 BC 新型治疗方法支出对 OCM 向实践支付的影响极小。
