The Oncology Care Model (OCM) is dead. The Oncology Care Model is a voluntary Alternative Payment Model (APM),”Include financial and performance accountability for events of care for cancer patients undergoing chemotherapy.” The OCM expires at the end of June 2022 and will be Enhanced oncology models. EOM is also a voluntary model and will run for 5 years: July 2023 to June 2028. [Note: Yes, there is a 1 year gap between the end of OCM and the start of EOM]
Like OCM, EOM allows oncologist group practices (PGPs) as well as other payers (eg, commercial payers, state Medicaid agencies) to participate in EOM—the latter through multi-payer agreements. Like OCM, under EOM, physicians pay an additional monthly fee to provide coordinated care for their cancer patients.Like OCM, EOM will measure the value of cancer patients based on the following metrics six months of care The initiation of chemotherapy (or similar targeted therapy) will be the onset of the attack.Like OCM, EOM physicians are eligible for performance-based retrospective payments (PBP) based on quality of care and cost savings over the six-month period of care (see EOM Fact Sheet, CMS slideshow). Cost saving bonuses and penalties are calculated as shown in the diagram below.
Seven cancers are included in the EOM. These include the following tumor types:
- breast cancer,
- chronic leukemia,
- Small bowel/colorectal cancer,
- lung cancer,
- lymphoma,
- multiple myeloma,
- prostate cancer
Patients were attributed to PGP based on the share of evaluation and management (E&M) services provided between initiation of chemotherapy and 6-month episodes. A PGP must provide at least 25% of all cancer-related E&M services during an episode to be attributable to an episode.
Unlike OCM plans, however, EOM’s monthly payments are less generous. Medical Landscape Report “The CMS Center for Innovation plans to more than halve monthly payments for enhanced oncology services in EOM ($70 vs. $160 in OCM), but at the same time, more work is expected to be done in practice.” Note that dual-qualified individuals each Get an additional $30 a month in MEOS payments ($100 total). Additional work includes additional data collection, such as “collecting electronic patient-reported outcomes (ePROs), and screening for social needs that may affect treatment, such as transportation problems and nutritional needs.” While collecting this data is certainly a good thing, it is not yet Find out if EOM will provide sufficient funding for the health system to collect these data. Additionally, physician group practices must provide “24/7 access to clinician, patient navigation services.”
On the positive side, HHS said It will “encourage other payers (e.g., commercial payers, state Medicaid agencies) to align with its core concepts to promote a consistent approach to the patient population of payers and EOM participants.” This could relieve physicians, hospitals, and health systems The burden of dealing with different items for different payer types.
Quality of care will be measured against the following areas:
- patient experience
- Avoidable acute care use
- Symptomatic toxicity management
- Social Mental Health Management
- Hospice Management
