Pathways to Prevention (P2P) Program

Gabriel A. Brooks, M.D., M.P.H.

Dr. Brooks

Geisel School of Medicine at Dartmouth

Presentation Abstract

Nutrition screening and nutrition interventions are widely acknowledged as having benefit for patients with cancer; however, many payers do not provide reimbursement for these services. Resultantly, practices providing outpatient cancer care must decide what level of resources to expend for these unreimbursed services. Alternative payment models, such as the Centers for Medicare and Medicaid Services’ Oncology Care Model (OCM), provide new incentive and regulatory structures that have potential to support provision of nutritional care in cancer treatment. The main incentives in OCM are the Monthly Enhanced Oncology Services (MEOS) payments and the episode total cost of care spending targets (which are used to calculate performance-based payments, or penalties). The MEOS payments provide practices with a consistent revenue stream that can defray costs of nutritional care. The episode spending targets provide an incentive for avoidance of costly treatment-related complications, such as hospitalizations. To the extent that nutritional care can prevent cancer treatment complications, provision of nutritional care could help practices to earn performance-based payments. OCM participants must also fulfill other program requirements, including the provision of a package of enhanced services, including depression screening and patient navigation. Future alternative payment models (from public-or private-payers) could include nutrition screening as an explicitly required service. In summary, alternative payment models for cancer care disrupt the fee-for-service status quo, providing new regulatory and incentive structures for cancer care delivery that may serve to facilitate provision of nutritional care as a component of cancer care.

About Dr. Brooks

Dr. Gabriel Brooks is an Associate Professor of Medicine at the Geisel School of Medicine, the Dartmouth-Hitchcock Medical Center, and the Dartmouth Cancer Center, all in Lebanon, New Hampshire. He holds a secondary appointment at the Dartmouth Institute for Health Policy and Clinical Practice. He is a practicing medical oncologist, and he is active in clinical and health care delivery research. He is the lead oncologist on a research team contracted by the Centers for Medicare and Medicaid Services to evaluate the Oncology Care Model. He has a research interest in the area of reducing toxicity from systemic cancer therapies, and he is the Principal Investigator of NCT04526886, Clinical Trial of a Novel Dose Adjustment Algorithm for Preventing Cytopenia-Related Delays During FOLFOX Chemotherapy.

Dr. Brooks did not disclose any conflicts of interest for this workshop.

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