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The 2006 CMS Demonstration Project is up and running, and the data collected from its participants in oncology may help to define and encourage quality patient care, said Christopher E. Desch, MD, National Director for the NCCN, who discussed the key elements of this year’s version.
The concept of a demonstration project, dating back to the 1960s, is to provide incentives to the economy and maintain or improve the delivery of health care services. Most of the current demonstration projects lie outside the field of cancer.
The 2005 CMS Demonstration Project in oncology was a new program that followed a change in chemotherapy reimbursement. It focused on the chemotherapy “encounter,” which emphasized the patient’s experience as it related to pain, nausea, and fatigue. It also created a new billing mechanism called the G code, which enabled physicians to receive payment for providing data on patient care.
The 2006 version of the project retains the G code framework, using it to focus on the services provided during an office visit, to compare the care rendered to national standards of care, and to create a more useful cache of claims data.
The 2006 CMS Demonstration Project is open to office-based physicians only, applies to Medicare fee-for-service patients (excluding HMO patients), and is applicable only when levels 2 through 5 are billed. In contrast to 2005, the level of clinical detail required for the 2006 version suggests that physicians, and not patients or nurses, will be filling out the forms.
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| Dr. Desch |
During his presentation, Dr. Desch walked conference participants through the three-part process of submitting patient information. “The first thing you do is write down the patient’s disease state, using the appropriate codes. Next, you note the reason for the patient’s visit, using the disease focus codes.”
For example, one notes whether the patient is being seen for work-up, evaluation, or staging; decision-making, treatment, or management of cancer or side effects; follow-up without active cancer, follow-up with active cancer (watchful waiting), palliative care, or an unspecified service not otherwise listed. Each of these options carries its own G code.
Dr. Desch continued on to describe the third part of the process. “Finally, you have to indicate whether you are adhering to established guidelines and identify the guidelines. If you are not following established guidelines, there are five codes describing reasons for nonadherence.”
Implementation of the project in the typical oncologist’s office should not be problematic. “It takes an extra minute or two during the visit, perhaps a little longer in the beginning of the year when you are learning the process, and a little longer to do it right,” he said. “But tools have been developed to simplify the process, including tear sheets, NCCN-mapped guidelines, and a CD-ROM developed by NCCN.
Dr. Desch expects there will be varied reaction to the 2006
project. “Some will look at it as a softening of the fall in reimbursement.
Some will see it as another form to fill out. Others might perceive it as
something more.” Dr. Desch is one who believes the 2006 Demonstration Project
may be something more—perhaps a platform to assessing cancer care quality on
the national level.
For Dr. Desch, the 2006 project is a valid data-collection program that will provide more detailed information on the cancer population and surpass previous similar-type programs. “It is not clear whether this program will meet Medicare’s objectives, since it is still an ‘experiment.’ The hope is that the information collected will help to explain the geographic disparities in health care spending and variation in clinical practice. We will also get information about how guidelines are used, and possibly how often deviations are clinically necessary.”
The information culled from patient visits can be linked to claims data related to diagnosis and treatment. “This will create a very rich database of the population of cancer patients over 65 that will reveal variations in care according to locale, hospital, and individual physician. The final result will be a national registry that offers the opportunity to evaluate quality, cost, and outcomes,” said Dr. Desch.