Ethan Basch, MD, MSc, is the lead author of an article in the Journal of the American Medical Association that provides perspectives on the Centers for Medicare & Medicaid Services’ (CMS) proposed new payment model for medical oncology care. Called Oncology Care First, it will replace Medicare’s current payment model, the Oncology Care Model, which is set to expire at the end of this year.
The Oncology Care Model, for which Basch serves as an advisor, was launched in 2016, and is notable for its emphasis on value-based care. The new Oncology Care First model will require practices to implement patient-reported outcomes for symptom monitoring during cancer treatment.
Research, including by Basch, has demonstrated that cancer patients who proactively reported their symptoms experience significantly improved quality of life, reduced emergency room visits, and improved overall survival.
He has conducted this work with other UNC Lineberger colleagues, including: Antonia Bennett; Allison Deal, MS; Angela Stover, PhD; Mattias Jonsson; Arlene Chung, MD, MHA, MMCi; Bill Wood, MD; and Angie Smith, MD. Collectively, their work has contributed to UNC Lineberger becoming a global leader in the area of patient-reported outcomes research.
Systemic challenges implementing patient-reported outcomes
Despite these studies, not all patients or physicians will be open to a system designed to capture patient-reported outcomes.
Logistical and cost challenges will need to be addressed, contends Basch, and his coauthors, Lalan Wilfong, MD, from Texas Oncology in Dallas, and Deborah Schrag, MD, MPH, from Dana-Farber Cancer Institute in Boston. In addition, they state patients “must be successfully and durably engaged” for a program to work, and physician practices should be offered guidance in how to implement a program, including staffing issues, training patients, and selecting and administering questionnaires and software.
“The CMS has taken an important step in helping to lead practice transformation by rewarding practices that systematically engage patients and make it seamless for clinicians to respond to their problems,” the authors write.
As for implementation of patient-reported outcomes, they note that “although it may take several iterations to get the details worked out, this bold step lays the groundwork for aligning reimbursement with patients’ well-being.”