Robert "Bo" Gamble
A year after announcing its intention to launch the Oncology Care Model (OCM) alternative payment plan for oncology care, The Centers for Medicare & Medicaid Services said it has 196 practices enrolled across the United States and that the official start date is Friday, July 1.
The OCM is designed to reduce the outlay for oncology spending while improving the quality of care. CMS said this will be achieved with financial incentives that encourage better coordination of care and elimination of unnecessary care.
“The Oncology Care Model encourages greater collaboration and information sharing so that cancer patients get the care they need,” Health and Human Services Secretary Sylvia M. Burwell said in a statement.
Practice administrators interviewed by OncLive
said they had mixed feelings about participating in the OCM. They said they recognize that value-oriented care is going to be the emphasis at CMS from now on, and they want to be involved as new systems and policies are introduced; however, they said the preparations have been very complex. They said CMS has not provided enough information and that CMS’s data requirements for performance measurement have been difficult to fulfill.
“I hate baptism by fire, meaning I wish we had more time so we could think it through,” said Barry Russo, CEO of The Center for Cancer and Blood Disorders in Texas. “But at the end of the day, I really want to make sure we learn, and that we understand how to optimize the process and reporting of value-based care, so that we’re prepared for where we think the market is going.”
The OCM breaks practice payment down into 6-month episodes of patient care, which are triggered by the start of administration of chemotherapy. Practices are required to track all related care, such as hospital admissions. The OCM allows a $160 monthly payment per patient, which CMS hopes will promote “timely, coordinated treatment.” In addition, practices may be eligible to share in the savings they achieve for CMS.
“The Oncology Care Model encourages practices to improve care and lower costs through episodic and performance-based payments that reward high-quality patient care,” CMS said in a statement, noting that the National Institutes of Health estimates that cancer costs will reach $158 billion by 2020, a climb of 27% from 2010. “The Oncology Care Model is one of the first CMS physician-led specialty care models and builds on lessons learned from other innovative programs and private-sector models,” CMS said.
Under the OCM, practices will be required to do the following, all of which are designed to improve responsiveness to patients, improve quality of care, reduce unnecessary billing, and coordinate care:
- Follow nationally recognized treatment guidelines.
- Provide 24/7 access to care by having representatives with access to patient information available by phone.
- Coordinate diagnostics and patient care with other physicians.
- Make sure that test data is received in advance of patient visits so that unnecessary repeat visits do not occur.
- Provide access to such resources as “emotional support groups, pain management services, and clinical trials.”
CMS said that the number of participating practices is nearly double what it expected to have by this phase of the program, which now undergoes a 90-day phase-in with relaxed performance standards, and then will continue for five years, during which practices will be encouraged to take on more risk for failure to meet performance expectations.
The amount of confusion behind the scenes was described by Robert “Bo” Gamble, director of strategic practice initiatives for the Community Oncology Alliance in Washington, DC. Gamble said that when the OCM was first announced as many as 400 practices began the application process but a large proportion balked upon discovering the level of difficulty. Following that, COA assembled a team to develop models and fact-find so that it could advise and educate its members who wanted to continue with the process. That process has been essential, as many practices have felt that CMS has not provided enough information to clarify how the program will work, Gamble said, though he said many practice administrators are still confused about whether they can succeed with the OCM.
CMS said it also has 17 payers enrolled in the program and it hopes to coordinate with them in order to bring costs down and improve care quality. It said “Medicare arm of the Oncology Care Model includes more than 3,200 oncologists and will cover approximately 155,000 Medicare beneficiaries nationwide.”
CMS officials were not readily available for an interview about the OCM launch.