The Oncology Care Mannequin (OCM) is useless. The Oncology Care Mannequin was a voluntary, different 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 may run for five years: July 2023 by means of 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., business payers, state Medicaid companies) to take part in EOM–the latter by means of multi-payer agreements. Like OCM, below EOM physicians are paid a further month-to-month price to supply 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 value financial savings throughout these six month episodes of care (see EOM Truth Sheet, CMS slides). The way in which price financial savings bonuses and penalties are calculated are proven within the figures beneath.
There are seven sorts of cancers which are 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 primarily based on primarily based on the share of analysis and administration (E&M) companies offered between initiating chemotherapy and the 6-month episodes. The PGP should present at the very least 25% of all cancer-related E&M companies through the episode to be attributed the episode.
Not like the OCM program, nonetheless, the EOM month-to-month funds are much less beneficiant. Medscape stories that “the CMS Innovation Middle plans to chop the Month-to-month Enhanced Oncology Providers funds within the EOM by greater than half ($70 vs $160 for the OCM), however on the similar time, expects extra work from practices.” Notice that the dually eligible people get a further MEOS fee of $30 (i.e., $100 whole) per 30 days. The extra work consists of further information assortment comparable to “assortment of digital patient-reported outcomes (ePROs), and screening for social wants that will have an effect on remedy, comparable to transportation points and dietary wants.” Whereas accumulating these information are actually a great 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 optimistic facet, HHS has acknowledged that it’ll “encourage different payers (e.g., business payers, state Medicaid companies) to align with its core ideas to advertise a constant method throughout payers and EOM contributors’ affected person inhabitants.” This might scale back the burden on physicians, hospitals and well being techniques to should cope with totally different applications throughout totally different payer sorts.
High quality of care will probably 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