The Oncology Care Model (OCM), an alternative payment model that the Centers for Medicare & Medicaid Services launched in 2016, expires on June 30, 2022. oncology (EOM) to build on some lessons learned in CMO and add a focus on equity.
EOM is a voluntary model that will run for five years, from July 2023 to June 2028. Participants in the model will include oncology practices that treat people with Medicare undergoing chemotherapy for breast cancer, chronic leukemia, cancer of the lung, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.
Participating providers will also provide enhanced services such as patient navigation, care planning, electronic patient-reported outcome (ePRO) collection, and screening for social needs that may affect treatment, such as transportation and nutritional needs. EOM will also encourage other payers to align with its core concepts to promote a consistent approach between payers and the patient population of EOM participants.
EOM implements a two-part payment structure for EOM participants to encourage the provision of improved services while creating incentives to reduce avoidable costs and usage and improve quality of care. MOE participants will be responsible for the full cost of care for a 6-month episode. Based on total episode spend and quality performances, EOM participants have the potential to earn a performance-based payment (PBP) or owe CMS a performance-based recoupment (PBR). The PBP and PBR quantities will be adjusted according to the actual quality performance.
EOM participants will also have the option to bill a Monthly Enhanced Oncology Services (MEOS) payment per beneficiary per month for providing enhanced services to EOM beneficiaries during each 6-month episode. EOM includes an additional MEOS payment for doubly eligible recipients, recognizing the greater resources that may be needed to care for complex and underserved communities.
“There are deep inequalities in the ability of people with cancer across race, gender, region and income to access cancer screening, diagnosis and treatment,” said CMS Administrator Chiquita Brooks-LaSure, in a statement. “CMS is working to advance President Biden’s Cancer Moonshot goals by helping Medicare cancer patients better navigate a difficult and often overwhelming journey. The Oncology Improvement Model will inspire participating oncology practices – including those in rural and underserved areas – to improve the delivery of coordinated, high-quality care that meets patients’ social needs and improves patient support and caregivers.
In addition to requiring participants to screen for health-related social needs, the MOE includes other design elements that contribute to CMS’s commitment to advancing health equity, including:
- Provide additional payment to participating oncology practices that provide enhanced services to patients eligible for both Medicare and Medicaid,
- Require participating providers to report patient demographics (e.g., race, ethnicity, language, gender identity) and
- Require participating providers to develop plans showing how they will address health equity gaps in their patient population.
President Biden has set new national goals: to reduce the cancer death rate by at least 50% over the next 25 years and to improve the experience of people and their families living with and surviving cancer.
Earlier this month, HHS announced $215 million in first-year funding grants over five years, $1.1 billion investment into three national cancer prevention and control programmes. In May, HHS announced the $5 million availability for Community Health Centers, funded by the HHS Health Resources and Services Administration, to increase equitable access to lifesaving cancer screenings.
In a statement, Ted Okon, executive director of the Community Oncology Alliance, released a statement with an initial response to the design of the model. He said community oncology practices are fully committed to positive, patient-centered improvement in cancer care and look forward to supporting CMMI and practices in making EOM a success.
“A significant concern is that CMMI is reducing monthly payments for enhanced oncology services (MEOS) in EOM by almost half of OCM ($70 in EOM versus $160 in OCM), while expecting more work from the firms,” he wrote. . “COA is extremely supportive of social health needs screening and electronic patient-reported outcomes (ePRO), it seems unfair to burden practices with more work but pay less, especially since practices are facing the return of the Medicare receiver. cutting, inflation and the ongoing challenges of practicing COVID-19. We hope to hear more from CMMI about this.
Okon also noted that the COA is disappointed that there remains an unnecessary one-year gap between the end of the CMO and the start of the MOE. “During this period, practices will have to assume the significant investments and operational changes put in place to benefit patients without reimbursement.”