CMS: Oncology Care Model Will Be Tough But Worth It

Tony Hagen @oncobiz
Published: Tuesday, Jul 19, 2016
Ron Kline

Ron Kline, MD

As a medical officer at CMS with responsibility for putting together the Oncology Care Model (OCM), Ron Kline, MD, is accustomed to hearing oncologists’ concerns that the bar is being raised too high for them. Some contend that they are already practicing to the highest standards and are as efficient as they can be, Kline says. He responds with an anecdote about a time that he met with a group of such physicians.

“As we were walking out the door I said, ‘What I hate is when your patient ends up in the emergency department (ED) and you don’t hear about that, and 3 days later you find out your patient’s been admitted to the hospital.’ And to a person, every one of those practice physicians nodded and said, ‘Yes, that happens to me, too!’ I looked at them and said, ‘You know what? Fix that, and you have a lot of room for improvement.’”

The OCM launched this month after 2 years of preparation by CMS. There are 195 practices participating from across the United States. Practice administrators, physicians, and their industry representatives have expressed concerns about the complexity of the alternative payment model (APM), the sluggish pace at which CMS has completed the stages necessary for launch, and the clarity of the information CMS has provided.

In an interview with OncLive about the OCM, Kline, who works in the office in the Patient Care Models Group in the CMS Innovation Center, explained that there are bound to be technical difficulties with an ambitious program of this scope: “We have done our very best to really shape the OCM and to address concerns fairly. Obviously, you’re learning as you go and you’re fixing things as you go.” Practice representatives have steadily come forward with concerns that were not covered by previous guidance from CMS. “No matter how detailed you think you are, there’s somebody out there for whom it’s not detailed enough, and they’ve got a unique set of circumstances that they need to address,” Kline says.

Eventually, the OCM will deliver on its promise to achieve lower costs and better outcomes, Kline predicts. Nobody knows better than an oncologist what’s really going on with an oncology patient; therefore, the idea is to coordinate better with other specialists, so that patients get directed to the right care at the right time, he says.

For example, “If a physician gets a call at 6 am in the morning and the patient needs to be seen, one answer is, well, ‘Go to the emergency department.’ Another alternative may be for an oncologist to get out of bed a little earlier and meet the patient in the office at 7:30 am and try to deal with the problem in that way.”

CMS also wants to see practices adhering better to nationally accepted treatment guidelines. In some cases, not following guidelines is justified, Kline says, but “evidence has shown that when you follow national guidelines, you provide better care, patients do better, there’s less toxicity, and there’s actually more high-value care. Doing that is important.”

That makes it sound easy for physicians and CMS to achieve value-based goals under the OCM, but Kline acknowledges that the model has “many moving parts” and has been evolving over 2 years as CMS has tried to come up with a system that would work for all types of oncology practices across the United States.

Starting from the July 1 launch, there’s a 90-day grace period with relaxed standards, after which oncology practices will have greater responsibility for meeting goals. The refining and tweaking process will continue for the 5-year duration of the OCM, after which CMS expects to have a much more workable APM. Meanwhile, CMS will offer regular webinars and other types of support to help enrolled practices adjust to the tighter set of expectations.

CMS programs may be in flux as a result of congressional testimony this month by Acting Administrator Andy Slavitt, who said a delay in implementing the Medicare Access and CHIP Reauthorization Act (MACRA) is likely because many practices are not ready for the higher standards. However, Kline says the OCM technically will not be considered a part of MACRA until physicians enrolled in the OCM start to assume a two-sided risk framework with penalties for failure to meet standards.

Another possible change is a reduction in drug payments under Medicare Part B. Some OCM practices worry about having to shoulder this change in addition to the OCM requirements, but Kline says the proposed change remains under review, and he is not able to say whether OCM practices would be affected by it.

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