COA Says New Care Model Doesn't Go Far Enough

The Community Oncology Alliance (COA) has weighed in on a new system of higher value performance for oncologists announced by the Centers for Medicare & Medicaid Services (CMS), saying it is a step in the right direction but needs to be supported by broader reforms.

CMS on Thursday announced the launch of an Oncology Care Model (OCM) that contains goals and financial incentives for practitioners in cancer care. ASCO called it a landmark in making value-based oncology care an explicit goal; the COA agreed, but added, “It is critical that payment reform … must also be concurrent with an immediate fix to Medicare drug payments or all this payment reform will be for naught.”

“The model proposed by CMMI [Center for Medicare & Medicaid Innovation] is generally consistent with COA’s Oncology Medical Home payment model, although there are some questions and concerns that we need to address with CMMI, which has been very open to input,” the COA said in a statement.

The OCM represents the second in a series of specialty care models of Medicare payment, following the start last year of the Comprehensive ESRD Care Model for enhanced care to beneficiaries with end stage renal disease. OCM is a 5-year program set to start in 2016.

Participating providers will have to provide patient access around the clock, 7 days a week to a clinician who has ready access to patient records. The OCM includes monthly, $160-per-patient care management payments along with performance-based payments for OCM episodes. The monthly payment is designed to support the cost of managing and coordinating care for Medicare patients.

The COA said in its statement that small practices are disappearing and need stronger support from CMS.

“For too long we have been fighting the detrimental consolidation of physician-directed cancer clinics into large hospital systems, causing chemotherapy and other cancer treatments to be more expensive for patients and payers, including Medicare,” the group said.

“Community oncology practices have been on the forefront of implementing novel payment reform pilots with private payers. It’s good now to see progress on the Medicare front.”

The OCM initiative is part of the Department of Health and Human Services’ “better, smarter, healthier” program to obtain more value for the healthcare dollars being spent through the Medicare program.

HHS hopes to link 30% of traditional or fee-for-service payments through Medicare to value-based care through alternative payment models, such as Accountable Care Organizations (ACOs) by the end of 2016 and 50% of payments to such models by the end of 2018.

“HHS is focused on three key areas: linking payment to quality of care; improving and innovating in care delivery; and sharing information more broadly to providers, consumers and others to support better decisions while maintaining privacy,” the release said.

The OCM will cover nearly all cancer types and is a multi-payer model that includes Medicare fee-for-service (OCM-FFS) and other payers such as commercial insurance plans or state Medicaid agencies.