Evaluating the Impact of Oncology Care Model Reporting Requirements on Biomarker Testing and Treatment

Abstract

PURPOSE: The Oncology Care Model (OCM) is Medicare’s first alternative payment model program for patients with cancer. As of October 2017, participating practices were required to report biomarker testing of patients with advanced non–small-cell lung cancer (aNSCLC). Our objective was to evaluate the effect of this OCM reporting requirement on quality of care. METHODS: We selected patients with aNSCLC receiving care in practices in a nationwide de-identified electronic health record-derived database. We used an adjusted difference-in-differences (DID) logistic regression model to compare changes in biomarker testing rates (EGFR, ROS1, and ALK) and receipt of biomarker-guided therapy between patients in OCM versus non-OCM practices, before and after OCM implementation. RESULTS: The analysis included 14,048 patients from 45 OCM practices (n = 8,151) and 105 non-OCM practices (n = 5,897). The overall unadjusted rates for biomarker testing and receipt of biomarker-guided therapy increased over the study period (2011-2018) in both OCM (55.5% v 71.6%; 89.8% v 94.6%, respectively) and non-OCM (55.2% v 69.7%; 90.1% v 95.2%, respectively) practices. In the adjusted DID model, the rates of biomarker testing (odds ratio [OR], 1.09 [95% CI, 0.88 to 1.34]; P = .45) and receipt of biomarker-guided therapy (OR, 0.87 [95% CI, 0.52 to 1.45]; P = .58) were similar between OCM and non-OCM practices. CONCLUSION: OCM biomarker documentation and reporting requirements did not appear to increase the proportions of patients with aNSCLC who underwent testing or who received biomarker-guided therapy in OCM versus non-OCM practices.

Defining comprehensive biomarker‐related testing and treatment practices for advanced non‐small‐cell lung cancer: Results of a survey of U.S. oncologists

“…First, respondents reported high biomarker testing rates that match or exceed levels observed by recent U.S.‐based studies, whose results vary significantly by year, practice setting, and biomarker. 7 , 9 , 12 Rates of guideline utilization (NCCN, ASCO, or other) among respondents, which correlated with high testing rates and use of multi‐gene panels, were high overall (98.8%) and equal among academic versus community respondents and generalist versus specialist respondents. Consistent testing for EGFR , ALK , and ROS1 for patients with non‐squamous NSCLC reported by 100% of respondents (98% for BRAF ) suggests familiarity with earlier approved treatments associated with those biomarkers regardless of practice setting, specialization, or other respondent characteristics.…”

“…7,8 A 2020 analysis of 150 community oncology practices found that the percentage of patients receiving biomarker testing for EGFR, ALK, and/or ROS1 increased across practices from 2011 to 2018 (from about 55% to about 70%) but has since plateaued. 9 Rapid advancements in the diagnostic evaluation and treatment of NSCLC challenge oncologists to adapt their practices. Therefore, an American Society of Clinical Oncology (ASCO) taskforce comprised of representatives from community and academic oncology practices, the American Cancer Society (ACS) National Lung Cancer Roundtable (NLCRT), LUNGevity, the GO 2 Foundation for Lung Cancer, and the ROS1ders undertook this study to characterize U.S. oncologists' biomarker ordering practices, to determine the types of testing platforms used, and to ascertain the barriers to testing and subsequent impact of delays in testing on treatment decisions.…”

“… 7 , 8 A 2020 analysis of 150 community oncology practices found that the percentage of patients receiving biomarker testing for EGFR , ALK , and/or ROS1 increased across practices from 2011 to 2018 (from about 55% to about 70%) but has since plateaued. 9 …”

Understanding Contemporary Molecular Biomarker Testing Rates and Trends for Metastatic NSCLC Among Community Oncologists

“…They found no significant difference, although testing rates and biomarker-guided therapy decisions increased over time in both groups. 38 Even with improved testing rates, opportunities still exist to improve test ordering and reporting processes. In our study, testing rates were higher according to unstructured data (cohort B) than structured data (Cohort A), indicating limitations in capture of data in structured fields.…”