Opportunities for Savings in Risk Arrangements for Oncologic Care.

Importance: As the US accelerates adoption of alternative payment through global payment models such as Accountable Care Organizations (ACOs) or Medicare Advantage (MA), high spending for cancer care is a potential target for savings.

Objective: To quantify the extent to which ACOs and other risk-bearing organizations operating in a specific geographic area (hospital referral region [HRR]) could achieve savings by steering patients to efficient medical oncology practices.

Design, Setting, And Participants: This observational study included serial cross-sections of Medicare beneficiaries with cancer from 2010 to 2018.

Assessment of Patient Attribution to Care From Medical Oncologists, Surgeons, or Radiation Oncologists After Newly Diagnosed Cancer.

This cohort study uses data from the Surveillance, Epidemiology, and End Results–Medicare Linked Database to assess the attribution of patients with newly diagnosed lung, breast, colorectal, or prostate cancer to care from multidisciplinary specialists—medical oncologists, surgeons, or radiation oncologists—within 6 months after diagnosis.

Evaluation of Reliability and Correlations of Quality Measures in Cancer Care.

Importance: Measurement of the quality of care is important for alternative payment models in oncology, yet the ability to distinguish high-quality from low-quality care across oncology practices remains uncertain.

Objective: To assess the reliability of cancer care quality measures across oncology practices using registry and claims-based measures of process, utilization, end-of-life (EOL) care, and survival, and to assess the correlations of practice-level performance across measure and cancer types.

Design, Setting, And Participants: This cross-sectional study used the Surveillance, Epidemiology, and End Results (SEER) Program registry linked to Medicare administrative data to identify individuals with lung cancer, breast cancer, or colorectal cancer (CRC) that was newly diagnosed between January 1, 2011, and December 31, 2015, and who were treated in oncology practices with 20 or more patients.

Assessment of Racial Disparities in Primary Care Physician Specialty Referrals.

Importance: Disparities in quality of care according to patient race and socioeconomic status persist in the US. Differential referral patterns to specialist physicians might be associated with observed disparities.

Objective: To examine whether differences exist between Black and White Medicare beneficiaries in the observed patterns of patient sharing between primary care physicians (PCPs) and physicians in the 6 specialties to which patients were most frequently referred.

Trends in Contracting and Common Ownership Between Hospice Agencies and Nursing Homes.

Background: In recent years, policymakers have paid particular attention to the emergence of a robust for-profit hospice sector and increased hospice use by nursing home residents. Previous research has explored financial incentives for nursing home-hospice use, but there has been limited research on nursing home-hospice partnerships and none on the extent of nursing home-hospice common ownership.

Objective: To describe trends in nursing home-hospice contracting and common ownership and to identify potential tradeoffs in care provided by nursing homes and hospice agencies that share common ownership.

Effects of efforts to increase response rates on a workplace chronic condition screening survey.

Objective: Expanded health risk appraisal (HRA) surveys can help employers target chronic conditions for outreach or disease management interventions by providing data on the prevalences of conditions and their effects on work performance. However, concerns exist about the accuracy of this data because most HRAs have low response rates. We evaluated these concerns by examining the prevalences and work impairments associated with chronic conditions across four HRA subsamples that differed in intensity of recruitment effort.