Oncologists' experience in reporting cancer staging and guideline adherence: lessons from the 2006 medicare oncology demonstration.
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ABSTRACT:
SUBMITTER: Doherty J
PROVIDER: S-EPMC2835481 | biostudies-literature | 2010 Mar
REPOSITORIES: biostudies-literature
Publications
Oncologists' experience in reporting cancer staging and guideline adherence: lessons from the 2006 medicare oncology demonstration.
Doherty Julia J Tanamor Myra M Feigert John J Goldberg-Dey Judy J
Journal of oncology practice 20100301 2
A report on how accurately physicians used methodology in a nationwide demonstration by the Centers for Medicare & Medicaid Services to enhance quality of cancer treatment and care and promote evidence-based practices. ...[more]
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Project description:BackgroundHealth services researchers have studied how care from oncologists impacts treatment and outcomes for cancer patients. These studies frequently identify physician specialty using files from the Center for Medicare and Medicaid Services (CMS) or the American Medical Association (AMA). The completeness of the CMS data resources, individually or combined, to identify oncologists is unknown. This study assessed the sensitivity of CMS data to capture oncologists included in the AMA Physician Masterfile.MethodsOncologists were identified from three CMS data resources: physician claims, the National Plan and Provider Enumeration System Registry, and the Medicare Data on Provider Practice and Specialty file. CMS files and AMA data were linked using a unique physician identifier. Sensitivity to identify any oncologists, radiation oncologists (ROs), surgical oncologists (SOs), and medical oncologists (MOs) was calculated for individual and combined CMS files. For oncologists in the AMA data not identified as oncologists in the CMS data, their CMS specialty was assessed.ResultsIndividual CMS files each captured approximately 83% of the 17 934 oncologists in the AMA Masterfile; combined CMS files captured 90.4%. By specialty, combined CMS data captured 98.2% of ROs, 89.3% of MOs, and 70.1% of SOs. For ROs and SOs in the AMA data not identified as oncologists in the CMS data, their CMS specialty was usually similar to the AMA subspecialty; ROs were radiologists and SOs were surgeons.ConclusionUsing combined files from CMS identified most ROs and MOs found in the AMA, but not most SOs. Determining whether to use the AMA data or CMS files for a particular research project will depend on the specific research question and the type of oncologist included in the study.
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Project description:ContextThe Centers for Medicare & Medicaid Services (CMS) recently launched accountable care organization (ACO) programs designed to improve quality and slow cost growth. The ACOs resemble an earlier pilot, the Medicare Physician Group Practice Demonstration (PGPD), in which participating physician groups received bonus payments if they achieved lower cost growth than local controls and met quality targets. Although evidence indicates the PGPD improved quality, uncertainty remains about its effect on costs.ObjectiveTo estimate cost savings associated with the PGPD overall and for beneficiaries dually eligible for Medicare and Medicaid.DesignQuasi-experimental analyses comparing preintervention (2001-2004) and postintervention (2005-2009) trends in spending of PGPD participants to local control groups. We compared estimates using several alternative approaches to adjust for case mix.SettingTen physician groups from across the United States.Patients and participantsThe intervention group was composed of fee-for-service Medicare beneficiaries (n = 990,177) receiving care primarily from the physicians in the participating medical groups. Controls were Medicare beneficiaries (n = 7,514,453) from the same regions who received care largely from non-PGPD physicians. Overall, 15% of beneficiaries were dually eligible for Medicare and Medicaid.Main outcome measureAnnual spending per Medicare fee-for-service beneficiary.ResultsAnnual savings per beneficiary were modest overall (adjusted mean $114, 95% CI, $12-$216). Annual savings were significant in dually eligible beneficiaries (adjusted mean $532, 95% CI, $277-$786), but were not significant among nondually eligible beneficiaries (adjusted mean $59, 95% CI, $166 in savings to $47 in additional spending). The adjusted mean spending reductions were concentrated in acute care (overall, $118, 95% CI, $65-$170; dually eligible: $381, 95% CI, $247-$515; nondually eligible: $85, 95% CI, $32-$138). There was significant variation in savings across practice groups, ranging from an overall mean per-capita annual saving of $866 (95% CI, $815-$918) to an increase in expenditures of $749 (95% CI, $698-$799). Thirty-day medical readmissions decreased overall (-0.67%, 95% CI, -1.11% to -0.23%) and in the dually eligible (-1.07%, 95% CI, -1.73% to -0.41%), while surgical readmissions decreased only for the dually eligible (-2.21%, 95% CI, -3.07% to -1.34%). Estimates were sensitive to the risk-adjustment method.ConclusionsSubstantial PGPD savings achieved by some participating institutions were offset by a lack of saving at other participating institutions. Most of the savings were concentrated among dually eligible beneficiaries.
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