When the Centers for Medicare & Medicaid Services (CMS) released performance reports for the 181 practices enrolled in the Oncology Care Model (OCM) earlier this year, the action had the effect of creating as much confusion as it resolved. Practices were looking forward to finding out whether they qualified for bonus payments for exceptional performance. What some found out, however, was that they had to pay money back to CMS. Now, as participating practices anticipate the second round of performance reports, due at the end of August, they hope things will go more smoothly.
Other requirements for participating practices include giving each patient a 13-point care plan, recording patient information in a central database, and offering patients aroundthe- clock access to a clinician who can access medical records quickly. CMS provides monthly enhanced oncology services (MEOS) payments of 0 per patient per month to help practices institute necessary changes. The bulk of savings is expected to come from fewer hospital stays and emergency department (ED) visits and better use of hospice and palliative care options.
Figure. CMS' Timing of Performance Reconciliation Reports has Caused Adjustment Difficulties for Practices
Barbara McAneny, MD, a managing partner of New Mexico Oncology Hematology Consultants Ltd and president of the American Medical Association, said her practice was among those that received a ,000 performance-based payment for achieving savings below the targets set by CMS.
About 25% of participating practices received such payments, according to the Center for Medicare and Medicaid Innovation (CMMI); however, COA estimates that those particular practices account for just 10% to 15% of patients and doctors. Gamble said that based on an informal COA poll, just 15% of responding practices received performance-based payments.
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