CMS: Oncology Care Model Will Be Tough But Worth It

Tony Hagen @oncobiz
Published: Tuesday, Jul 19, 2016
Among the shortcomings of the state of readiness of the OCM, the launch of a portal for data uploading has been delayed. Additionally, practices have said it hasn’t been possible for them to model their financial outcomes sufficiently to determine how much they will be able to earn under the model. Kline says progress has been made on both of those fronts, partly with the launch in recent weeks of OCM-PREDCT for modeling payment.

“You can plug in a diagnosis and a set of comorbidities, age and gender, and the model will predict what the target price will be. What’s not running is the software registry that would accept data manually from physicians or upload from their own electronic health records into ours. It’s a complicated piece of software that’s made more complicated by the fact that it has to be completely secure. It’s actively being worked on.”

One big concern from the Community Oncology Association (COA), which represents hundreds of independent practices and has been helping OCM enrollees to find answers to questions about the model, is that the OCM apparently forces practices to compete against their own achievements—meaning that if they achieve economies, they will be penalized financially if they don’t improve upon those same achievements in subsequent years.

Kline says that’s not completely true. Practices are expected to improve on their own performance, but “the goal posts don’t move. What we did was create a personalized benchmark for every practice, so that every practice can improve against its personal best,” but minimum performance levels won’t be raised to make it more difficult.

Some practices favor the establishment of regional standards that practices would have to meet. Kline says that wouldn’t have challenged the best oncology practices in a region to do any better, and it would have been unfair to other practices that have huge obstacles to overcome in delivering more economical care. “The much more challenged practices would be so far off the regional price that there wouldn’t be anything they could do. They wouldn’t even bother to participate in the regional model.”

It’s not just a matter of knowing how a practice is going to be judged under this model, or whether practices will have all of the information needed to make accurate predictions about how much they will earn in pay for a particular patient. Some practice representatives have said that they don’t know yet whether all of their financial investments in the OCM are going to be covered. For example, CMS has provided for $160 monthly payments to practices for each patient undergoing a 6-month episode of care.

Eventually, practices will share in the savings they achieve for CMS. However, from the start, practices have had to hire nurse navigators, assign workers to cover the extra hours required for 24/7 patient assistance, and foot the bill for additional software and related technological support in order to make the OCM system conversion. Some anticipate that the expenses won’t stop there.

For his part, Kline says that the $160 monthly payments were intended to cover those extra needs. In the end, he says, the OCM will lead to higher value care, though it’s not going to be easy for practices or for CMS to achieve.

“Yes, you have to do more things than before, but the OCM is compensating you for that. The things that you’re doing will improve the quality of oncology care for patients throughout the country. I don’t think anyone has said to me the things that we’re doing won’t improve the quality of care. They’ve said the things that we’re doing are hard, and I agree.”

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