Alyssa Dahl, MPH
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) released the first round of reconciliation data from the Oncology Care Model (OCM) bundled payment program. As we at DataGen parsed through the information, we found that some of the practices that did well were surprised to learn they had achieved savings, and some participants were pleased to find out that their level of performance met expectations.
Despite this lack of clarity, several interesting pieces of information emerged from this initial reconciliation. For instance, this was the first time that participants saw the application of the novel therapy adjustment, which helped increase payments for eligible practices with greater adoption of newly FDA–approved oncology drugs. There is some confusion and a need for further assessment here, because some practices received a smaller payment adjustment than expected, and other practices didn’t receive an adjustment at all.
Distinct Performance Patterns
Additionally, we observed some distinct performance patterns. Although it was very difficult for practices to achieve savings on breast cancer episodes, many practices had the opposite experience with intestinal cancer episodes. Discussions with oncologists familiar with practice patterns for intestinal cancer suggested that the most common treatment regimens use drugs of similar costs, which helps the model produce more predictable target prices for intestinal cancer episodes. There was significant variation in spending patterns in breast cancer, and the target price model may require further breast cancer–specific risk adjustment to handle predictors of episode spending outside the provider’s control. For example, when an oncologist places a patient on a clinically indicated high-cost drug regimen with no comparable cost-efficient alternative, the model lacks the sensitivity to reflect its impact on episode cost within the target price.
The surprising results have motivated practices to dig deeply into the results of the first reconciliation and prepare for future ones. During performance period 1, most participants were not focused on improving financial performance—most of their efforts centered on collecting data and implementing care transformation requirements. Additionally, a lack of clarity on patient attribution (for purposes of physician payment) during the first performance period made it challenging to monitor aggregate performance.
As with any new initiative, monitoring of ongoing performance periods has become more manageable with experience. Participants anticipate that they will soon be able to measure the impact of their efforts spent on care transformation, using the next round of reconciliation data.
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