After conducting a retrospective review to identify clinical variables associated with increased risk of hospital admissions and emergency department visits, Mercy Cancer Care used these data to develop and implement a predictive algorithm that stratifies patients according to their 30-day risk of both events. A daily dashboard report identifies all patients as high, intermediate, or low risk. These dashboard risk scores are then used to proactively manage patients with referrals to services such as social work, dietitian, or evaluation for possible home care assistance. Ultimately, this QI initiative effort will allow proactive management of patients within 30 days of their outpatient chemotherapy—the OP 35 bundling payment initiative that CMS put into effect this year under its Hospital Outpatient Quality Reporting Program.
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Quality measure OP-35—the first chemo-specific measure in the Centers for Medicare & Medicaid Services Hospital Outpatient Quality Reporting Program—went into effect for payment determination this year. To be fully prepared, Mercy Cancer Care looked at 90,000 of their qualifying chemotherapy visits that met the criteria for measure OP-35 and identified the clinical variables associated with patients’ increased risk of hospital admissions or ED visits. Based on that data, Mercy developed a predictive algorithm that identifies and manages chemotherapy patients who are at high risk.
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