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June 29, 2022

The new Enhancing Oncology Model: What you need to know

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    CMS on Monday announced a new voluntary payment model that will build off the Oncology Care Model (OCM), which ends Thursday, Maya Goldman reports for Modern Healthcare.

    So far, the OCM has failed to lower total Medicare spending or significantly improve quality of care

    CMS announces its new oncology payment model

    CMS on Monday debuted its new oncology payment model, known as the Enhancing Oncology Model (EOM), which will launch a five-year test period on July 1, 2023. 

    Notably, the new model builds off the OCM, which is ending Thursday after six years. Under the new model, two risk arrangements will be available. However, both will subject participants to some downside risk.

    While Community Oncology Alliance (COA) executive director Ted Okon said the trade group supports the model's objectives and looks forward to making it successful, it is disappointed that the new model will not begin immediately after the OCM.

    "COA is disappointed that there will remain an unnecessary one-year gap between the OCM ending and EOM beginning. During this time practices will have to shoulder the extensive investments and operational changes put in place to benefit patients without reimbursement," Okon said.

    When the EOM goes into effect, participating physician group practices will be responsible for patient health quality and total spending over six-month episodes of care. Participants can either earn a performance-based payment or owe CMS a performance-based refund if total expenditures for episodes surpass a certain threshold.

    In addition, participants will choose whether to bill for a monthly enhanced payment of $70 for each beneficiary if additional services, including 24-hour access to a clinician, patient navigation services, and social-needs screenings are provided to eligible beneficiaries, Goldman writes. According to CMS, the agency may require participants to report their social-needs screening data during future model years.

    For dually eligible beneficiaries, CMS will pay an additional $30 per month. However, only the base $70 payment will be included for episode expenditures.

    While the enhanced monthly payment amount is lower than the monthly enhancement available under the OCM, CMS noted that the new amount is designed to help make it easier to save. According to Okon, the alliance is concerned that practices will be forced to take on additional work and get paid less under the new model.

    Participants must also disclose patient demographic data, including race, ethnicity, language, and gender identity, and they will be required to develop plans to address health equity gaps among their patients. In addition, CMS will require participants to gradually implement electronic patient reported outcomes.

    Oncology physician group practices that treat patients who are undergoing chemotherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine or colorectal cancer can apply for the program through Sept. 30.

    Private payers, Medicare Advantage plans, and Medicaid agencies can also apply to participate in the program and sign a memorandum of understanding with CMS. According to Goldman, "[t]he model will have one track for traditional Medicare enrollees, and another run by payers for their own eligible enrollees."

    "There are stark inequities in the ability of people with cancer across race, gender, region, and income to access cancer screening, diagnostics, and treatment," said CMS administrator Chiquita Brooks-LaSure. "CMS is working to advance President [Joe] Biden's Cancer Moonshot goals by helping Medicare cancer patients better navigate a challenging and often overwhelming journey." (Goldman, Modern Healthcare, 6/27)

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