Optimizing for Success in the Radiation Oncology Alternative Payment Model

The approval of CMS’s radiation oncology alternative payment model (APM) last month comes at what some might consider to be a difficult time in healthcare. (Sarcasm has become a key tool in my survival toolkit for 2020.) In a year of challenge and change, radiation oncology practices across the country have been randomized by zip code into a new payment model that pays a flat rate for treatment, with up to 4% of payment withheld based on performance and outcome metrics as well as a 3.75% (professional) or 4.75% (technical) discount factor taken off the top. The mandatory implementation goes into effect July 1, 2021.

With resources stretched and timelines short, the APM feels like the straw that broke the camel’s back, both operationally and financially. The good news though, is that there are really only two questions one needs to ask to succeed in the new APM:

Am I able?

Am I motivated?

Change management theory posits that the answers to these two questions must be mutually supportive in order for true change to occur. That is to say, if we ask someone to make an easy change in their life (check a box on a to-do list after seeing each patient, for example), the motivation to do so doesn’t need to be significant (let’s say $5 per patient). On the other hand, if the change we’re seeking is challenging – whether that be time-consuming, strenuous, or if the participant is uncertain they can achieve the desired outcome – the motivator must be sufficiently valuable to instigate the participant to change. 

To run a successful practice under the APM, the first question practices must ask is “Are we able?”. Answering this question involves understanding the guidelines, including the pay-for-reporting, pay-for-performance, and patient experience metrics that are incorporated in the model as the data elements are finalized. Then, creating a process for documentation and clearly communicating it early and often to clinicians will enable them to meet this goal. 

Next, practices must also ask “Are our clinicians motivated?”. This is where we, as an industry, tend to fall down. Enough has been written about EHRs and administrative burden that we can safely assume that most clinicians aren’t eager for additional documentation burden to continue to earn payment for their clinical services. As such, motivation becomes critical to incentivize clinicians to achieve the new requirements of the APM. Motivation is a fun and fascinating topic in medicine, but suffice it to say that this will likely vary by group, with the following always being true:

  • Transparency: show clinicians how they are performing on a regular, frequent basis
  • Peer Power: establish expectations by benchmarking clinicians’ performance against peers or a team average
  • Extrinsic Reward: tie clinicians’ success to the practice’s success and align financial incentives to their performance against the model – a rising tide lifts all boats, after all

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