The Oncology Care Mannequin (OCM) is lifeless. The Oncology Care Mannequin was a voluntary, various fee mannequin (APM), that “included monetary and efficiency accountability for episodes of care surrounding chemotherapy administration to most cancers sufferers.” OCM expired on the finish of June 2022, and shall be changed by the Enhancing Oncology Mannequin. EOM is a additionally a voluntary mannequin that may run for five years: July 2023 via June 2028. [Note: Yes, there is a 1 year gap between the end of OCM and the start of EOM]
Like OCM, EOM permits each oncology doctor group practices (PGPs) in addition to different payers (e.g., industrial payers, state Medicaid businesses) to take part in EOM–the latter via multi-payer agreements. Like OCM, below EOM physicians are paid an extra month-to-month payment to offer coordinated care to their most cancers sufferers. Like OCM, EOM will measure worth for most cancers sufferers primarily based on six-month episodes of care the place the initiation of chemotherapy (or comparable focused therapies) would be the initiating level of the episode. Like OCM, EOM physicians are eligible for retrospective performance-based fee (PBP) primarily based on high quality of care and price financial savings throughout these six month episodes of care (see EOM Reality Sheet, CMS slides). The best way price financial savings bonuses and penalties are calculated are proven within the figures beneath.
There are seven varieties of cancers which might be included in EOM. These embody the next tumor sorts:
- Breast most cancers,
- Persistent leukemia,
- Small gut/colorectal most cancers,
- Lung most cancers,
- Lymphoma,
- A number of myeloma,
- Prostate most cancers
Sufferers are attributed to PGP primarily based on primarily based on the share of analysis and administration (E&M) providers supplied between initiating chemotherapy and the 6-month episodes. The PGP should present no less than 25% of all cancer-related E&M providers throughout the episode to be attributed the episode.
Not like the OCM program, nevertheless, the EOM month-to-month funds are much less beneficiant. Medscape reviews that “the CMS Innovation Heart plans to chop the Month-to-month Enhanced Oncology Companies funds within the EOM by greater than half ($70 vs $160 for the OCM), however on the identical time, expects extra work from practices.” Word that the dually eligible people get an extra MEOS fee of $30 (i.e., $100 complete) per 30 days. The extra work contains further information assortment resembling “assortment of digital patient-reported outcomes (ePROs), and screening for social wants that will have an effect on remedy, resembling transportation points and dietary wants.” Whereas accumulating these information are actually a very good factor, it’s not clear if EOM will present ample funding for well being programs to gather these information. Additional, doctor group practices should provide “24/7 entry to a clinician, affected person navigation providers.”
On the constructive facet, HHS has acknowledged that it’s going to “encourage different payers (e.g., industrial payers, state Medicaid businesses) to align with its core ideas to advertise a constant strategy throughout payers and EOM individuals’ affected person inhabitants.” This might scale back the burden on physicians, hospitals and well being programs to need to take care of completely different applications throughout completely different payer sorts.
High quality of care shall be measured primarily based on the next domains:
- Affected person expertise
- Avoidable acute care utilization
- Administration of signs toxicity
- Administration of psychosocial well being
- Administration of end-of-life care
