New Oncology Care Model Reforms Payment System, Offers Performance-Based Incentives

Continuing with its focus on paying doctors for delivering higher quality care and lowering cost by discouraging them from providing unnecessary services, the CMS announced the launch of an Oncology Care Model (OCM) that contains goals and incentives for practitioners in cancer care.

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

Participating providers will have to offer patient access around the clock, 7 days a week to a clinician who has ready access to patient records. Patients must be treated with therapies consistent with nationally recognized clinical guidelines and comply with guidelines on improved collection and use of medical data.

Key elements of the refined payment model include 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. CMS said oncologists will have to meet the bar on a set of quality measures.

“This model will invest in physician-led practices, allowing the practices to innovate and deliver higher-quality care to their patients,” CMS officials said in the release. “CMS is seeking the participation of other payers in the model to leverage the opportunity to transform care for oncology patients across a broader population.”

CMS said the OCM comes in response to feedback from the oncology community, patient advocates and the private sector that “a new way of paying for and delivering oncology care is needed.”

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

HHS hopes to link 30 percent 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 percent 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.

The initiative is supported by the American Society of Clinical Oncology which late last month noted that it was the first time in Medicare history that “explicit goals” had been set to make value-based care a factor in payment. ASCO said the OCM “aligns with ASCO's own proposal to reform payment for oncology care,” released in May 2014.