The Oncology Care Mannequin (OCM) is useless. 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 will probably be changed by the Enhancing Oncology Mannequin. EOM is a additionally a voluntary mannequin that can run for five years: July 2023 by 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 by multi-payer agreements. Like OCM, underneath EOM physicians are paid an extra month-to-month price to supply coordinated care to their most cancers sufferers. Like OCM, EOM will measure worth for most cancers sufferers based mostly on six-month episodes of care the place the initiation of chemotherapy (or related focused therapies) would be the initiating level of the episode. Like OCM, EOM physicians are eligible for retrospective performance-based fee (PBP) based mostly on high quality of care and price financial savings throughout these six month episodes of care (see EOM Reality Sheet, CMS slides). The way in which price financial savings bonuses and penalties are calculated are proven within the figures under.
There are seven kinds of cancers which can be included in EOM. These embrace the next tumor sorts:
- Breast most cancers,
- Persistent leukemia,
- Small gut/colorectal most cancers,
- Lung most cancers,
- A number of myeloma,
- Prostate most cancers
Sufferers are attributed to PGP based mostly on based mostly on the share of analysis and administration (E&M) companies supplied between initiating chemotherapy and the 6-month episodes. The PGP should present a minimum of 25% of all cancer-related E&M companies 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 experiences 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.” Be aware that the dually eligible people get an extra MEOS fee of $30 (i.e., $100 whole) monthly. The extra work consists of further information assortment akin to “assortment of digital patient-reported outcomes (ePROs), and screening for social wants which will have an effect on therapy, akin to transportation points and dietary wants.” Whereas gathering these information are definitely a superb factor, it’s not clear if EOM will present enough funding for well being techniques to gather these information. Additional, doctor group practices should provide “24/7 entry to a clinician, affected person navigation companies.”
On the constructive facet, HHS has said 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 method throughout payers and EOM members’ affected person inhabitants.” This might cut back the burden on physicians, hospitals and well being techniques to should cope with totally different packages throughout totally different payer sorts.
High quality of care will probably be measured based mostly 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