Use of treatment pathways reduce cost and decrease ED utilization and unplanned hospital admissions in patients (pts) with stage II breast cancer.

Abstract

e12012 Background: VIA Oncology evidence-based pathways have been integrated into our medical oncology workflows since November 2014. Within 3 months, compliance was high for our 42 medical oncologists at 19 sites working with a common EHR with over 85% of pts treated on pathway. The aim of this study was to determine if there was a significant difference in the overall cost of treatment between pts treated on pathway versus off pathway, and whether on pathway pts had a lower rate of ED use and unplanned admissions within 30 days of chemotherapy as required in the new CMS directives. Methods: Newly diagnosed stage 2 breast cancer pts diagnosed between January 1, 2016 to December 31, 2017 were identified from the tumor registry for the system. The VIA database was queried to separate these pts into two groups–those pts who were treated on pathway, and those who were off pathway. The data warehouse was utilized to determine the total charges of adjuvant medical oncology treatment for these pts. In addition, data was extracted for the same groups to determine those pts who sought ED evaluation and or hospital admission within 30 days of chemotherapy treatment. Statistical analysis was performed utilizing Fisher’s exact test to compare proportions and t-test to compare treatment costs and ED/hospitalizations between the on and off pathway groups. Results: During the 2 years, 412 (93%) Stage 2 breast cancer pts were treated on pathway (including clinical trials); 32 (7%) were off pathway. 81% of the on-pathway group were + for ER and/or PR and 17% were HER-2 +; 78% of the off-pathway group were + for ER and/or PR and 38% were HER-2 +. Mean cost for treating the on-pathway group was $111,067 compared to $200,717 for the off-pathway pts (p=0.01). 18.8% of the off-pathway pts were seen in the ED / unplanned admissions and had more multiple visits compared to 12.1% of on-pathway pts within 30 days of chemotherapy (p=0.026). Conclusions: Standardized usage of evidence based pathways can be used successfully across a large number of providers over wide geography. Adherence to pathways results in significant cost savings for each patient, and significant reduction in ED/hospital utilization for on pathway patients.

Integrating Academic and Community Cancer Care and Research through Multidisciplinary Oncology Pathways for Value-Based Care: A Review and the City of Hope Experience

“…In the southwest, Dr. McAneny expanded on her New Mexico medical home model to engage six other US oncology practices in the successful Center for Medicare and Medicaid Innovation (CMMI)-funded COME HOME project [ 8 ]. Oncology pathways are a major component of these programs, with studies of implemented pathway programs showing equal or improved outcomes with lower costs in medical oncology [ 12 , 13 , 14 , 15 , 16 , 17 ], as well as in other disciplines including surgery, radiation oncology, supportive care, and end of life [ 18 , 19 , 20 , 21 , 22 , 23 ]. The evaluation and adoption of oncology pathways were further stimulated by Center for Medicare and Medicaid Services (CMS)’s oncology care MIPPs and Oncology Care Model (OCM) alternate payment programs and private payer pilots with academic and community-based networks and various private payors [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”