In a study reported in JAMA Network Open, Christopher R. Manz, MD, MSHP, and colleagues found that oncologist participation in the Medicare Oncology Care Model (OCM) was not associated with a reduced likelihood of prescribing novel cancer therapies to their patients.
As stated by the investigators, “Medicare’s OCM was an alternative payment model that tied performance-based payments to cost and quality goals for participating oncology practices. A major concern about the OCM regarded inclusion of high-cost cancer therapies, which could potentially disincentivize oncologists from prescribing novel therapies.”
Christopher R. Manz, MD, MSHP
Study Details
The study used Surveillance, Epidemiology, and End Results (SEER) Program data and Medicare claims to compare receipt of novel therapies for patients treated by oncologists participating (OCM group) vs not participating (non-OCM group) in the OCM in the period before (January 2015–June 2016) and after (July 2016–December 2018) OCM initiation. Patients were Medicare fee-for-service beneficiaries in SEER registries eligible to receive 1 of 10 novel cancer therapies approved by U.S. Food and Drug Administration in the 18 months before OCM implementation. Patients in the OCM vs non-OCM groups were matched for novel therapy cohort, outcome time period, and oncologist specialist status.
Key Findings
The study population consisted of 2,839 matched patients, including 760 in the OCM group and 2,079 in the non-OCM group. For patients in the OCM vs non-OCM group, 39.9% vs 33.2% received novel therapies before and 50.3% vs 40.1% received novel therapies after OCM initiation (adjusted difference-in-differences = 3.5 percentage points, 95% confidence interval [CI] = −3.7 to 10.7 percentage points, P = .34).
When novel drug cohorts were analyzed separately, OCM participation was associated with a significant increase in patient receipt of novel therapy only for second-line immunotherapy for lung cancer (difference-in-differences = 17.4 percentage points, 95% CI = 4.8–30.0 percentage points, P = .007). Other cohorts showed no significant differences in receipt of novel therapy or had sample sizes too small for analysis.
Overall, patients in the OCM group were more likely to receive novel therapies both before and after OCM initiation. Over the entire study period, patients with oncologists participating in the OCM were more likely to receive novel therapies than those with nonparticipating oncologists (odds ratio = 1.47, 95% CI = 1.09–1.97, P = .01).
The investigators concluded, “This study found that participation in the OCM was not associated with oncologists’ prescribing novel therapies to Medicare beneficiaries with cancer. These findings suggest that OCM financial incentives did not decrease patient access to novel therapies.”
Dr. Manz, of the Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was funded by a Conquer Cancer Foundation 2020 Young Investigator Award from Genentech and the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
