OBJECTIVES : The Center for Medicare and Medicaid Innovation’s Oncology Care Model (OCM) is an alternative payment model utilizing financial incentives to promote quality care. Due to the significant financial investment and novelty of the program, it is important to gain an early understanding of OCM’s impact in order to support the development and implementation of the model. This study examined end-of-life (EOL) care among decedent cancer patients in the newly implemented OCM.

METHODS : We identified decedent beneficiaries age >65 in an academic medical center following OCM implementation on 7/1/16. This early evaluation uses data from OCM Feedback Reports encompassing 7/1/16-3/1/18. Within 30 days of death, intensive EOL care was measured by receipt of hospice care, >1 hospitalization, and >1 intensive care unit (ICU) admission. Intensive EOL chemotherapy use was measured within 14 days of death. The Cochran-Armitage test with Monte Carlo estimation was used to evaluate time trends from quarter 1 (Q1) of OCM to quarter 7 (Q7) for each EOL measure separately and for an aggregate intensive EOL measure including hospitalization, ICU, and chemotherapy utilization.

RESULTS : A total of 355 decedent patients were included in the study. In this population, the mean age was 74, 61% were male, and 81% were white. The proportion of beneficiaries receiving hospice care trended from 65.0% in Q1 to 67.3% in Q7 (p=0.739). The aggregate intensive EOL measure trended from 65.0% in Q1 to 57.7% in Q7 (p=0.178). For separate EOL measures there was a reduction from Q1 to Q7 in hospitalizations (60.0 to 53.8;p=0.367), ICU admissions (37.5 to 23.1;p=0.331), and chemotherapy utilization (17.5 to 7.7;p=0.207). No statistically significant difference was observed overall.

CONCLUSIONS : Promising trends towards reducing intensive EOL measures suggest OCM’s initiatives may be improving quality of care. Further studies should be conducted as more data becomes available and practices gain experience with the OCM.