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Oncology Practice Management - March 2015, Vol 5, No 2 - Payment Reform
Rosemary Frei, MSc

The announcement in February of a new Oncology Care Model has brought a lukewarm response by the American Society of Clinical Oncology (ASCO). Developed by the Centers for Medicare & Medicaid Services (CMS) Innovation Center and announced through the US Department of Health & Human Services, the new care delivery model encompasses a multipayer structure as well as incentivized and monthly per beneficiary payments to participating practices (see article on this page).

In August 2014, the Innovation Center, known officially as the Center for Medicare & Medicaid Innovation (CMMI) posted and sought comments online for the proposed model, titled “Preliminary Design for an Oncology-­Focused Model.” The new model was announced February 12, 2015. That same day ASCO issued a news release outlining what its officials see as challenges with the new model. ASCO Chief Medical Officer Richard L. Schilsky, MD, FACP, FASCO, echoed these concerns when reached by Oncology Practice Management.

“While CMS is to be commended for seeking new approaches to payment, we are disappointed they have chosen to pursue only one model—and one that continues to rely on a broken fee-for-service system,” Dr Schilsky stated in an e-mail to the journal. “ASCO looks forward to working with both public and private payers to explore new payment strategies that better reflect modern oncology practice and support high-value, patient-centered care.”

During the period for comments on the proposal, ASCO Chief Executive Officer Allen S. Lichter, MD, FASCO, submitted a letter to CMS detailing the organization’s concerns with the proposal. He took issue with most aspects of it. With respect to the calculation of performance-based payments, Dr Lichter wrote that, “CMMI should provide a transition period where it does not calculate and retain a discount on the target cost of per­formance period episodes,” and “CMMI should defer implementing any hold-back retained by Medicare until after the first 2 performance periods are completed.”

He noted, in addition, that ASCO has been developing its Consolidated Payments for Oncology Care (CPOC) model. He concluded that CPOC, which ASCO released in May 2014, “shares a number of important policy goals with the [Oncology Care Model] framework, and our model is designed to provide Medicare and other payers with the flexibility to incorporate its key components into a variety of reform approaches. We would very much like to work with you to explore ways that we can leverage our respective efforts to build a better payment system in oncology.”

CMS declined Oncology Practice Management’s requests for comment regarding ASCO’s concerns.

The Oncology Care Model developed through CMMI offers eligible practitioners a $160 per-beneficiary, per-month payment for a 6-month episode of chemotherapy care, as well as the potential for an incentivized, performance-based payment for care episodes. Participating practices must adhere to specified guidelines and requirements, and demonstrate the capabilities to provide and document care as outlined in the Oncology Care Model (OCM) Request for Applications (RFA) February 2015. CMS is also soliciting participation from other payers, including commercial insurers, state agencies, and government payers.

For more information, interested practices can download the application from http://innovation.cms.gov/Files/x/ocmrfa.pdf. Practices that are interested in participating are required to submit a nonbinding letter of intent by May 7; interested payers must submit letters of intent by April 9.

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Last modified: July 9, 2015
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