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CMS Offers New Accountable Care Payment Model for Oncologists

By Jennifer Bresnick

- CMS is already making good on its commitment to expanding accountable care by announcing new opportunities for value-based reimbursement for oncologists.  Providers participating in the new Oncology Care Model (OCM) will receive bundled payments for episodes of care, which drive shrewd utilization of resources, cut costs, and promote improved outcomes.

The Centers for Medicare and Medicaid Services

“Based on feedback from the medical, consumer and business communities, we are launching this new model of care to support clinicians’ work with their patients,” said Patrick Conway, MD, CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality. “We aim to provide Medicare beneficiaries struggling with cancer with high-quality care around the clock and to reward doctors for the value, not volume, of care they provide. Improving the way we pay providers and deliver care to patients will result in healthier people.”

The new model puts the spurs to Secretary Sylvia Burwell’s plan to transform at least 50% of traditional Medicare payments into value-based reimbursement by 2018.  With oncology care costing approximately $263 billion annually in medical costs and lost productivity, the complex specialty is a prime target for transformation.  Physician-led practices will be among the first to receive bundled payments for cancer treatments, as well as a monthly care management payment for each Medicare patient undergoing care.

The payment structure will support coordinated, accountable care that meets the three primary goals of the value-based revolution: typing reimbursement to care quality, raising the level of innovation and improvement in care delivery, and promoting data exchange between partners to promote coordination, better decision-making, and reductions in repeated services.

“With the Oncology Care Model, CMS has the opportunity to achieve three goals in the care of this medically complex population who are facing a cancer diagnosis: better care, smarter spending, and healthier people,” Conway said. “As a practicing physician and son of a Medicare beneficiary who died from cancer, I know the importance of well-coordinated care focused on the patient’s needs.”

The new model has received mixed reviews from oncology groups including the American Society of Clinical Oncologists (ASCO).  While the ASCO believes the OCM is a step in the right direction, “we are disappointed they have chosen to pursue only one model – and one that continues to rely on a broken fee-for-service system,” said ASCO Chief Medical Officer Richard Schilsky, MD, FACP, FASCO.

ASCO believes that oncologists should be required to meet a robust set of quality and outcome measurements in order for reimbursements to be effectively tied to value, including benchmarks for hospitalizations, emergency room use, and mortality rates.  In a commentary submitted to CMS, ASCO states that the goal of effective accountable care reimbursements would “utilize appropriately aligned financial incentives, including performance-based payments, to improve care coordination, appropriateness of care, and access for beneficiaries undergoing chemotherapy, resulting in improved health outcomes, higher quality care, and lower expenditures.”

“Financial incentives for appropriate care should reduce health care expenditures as participating practices collaboratively and comprehensively address the complex care needs of the beneficiary population receiving chemotherapy treatment, while decreasing the use of services that do not improve health outcomes.”

The ASCO’s ideal oncology payment model would leverage a two-tier reimbursement system that would include the monthly care management fee as well as a measure-based financial incentive based on past performance.  This would better encourage providers to raise quality and outcomes while providing a stable reimbursement basis for a six-month episode of care.

“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,” said Schilsky.

CMS is also looking forward to engaging more payers for the new scheme, including Medicare Advantage and Medicaid managed care plans, commercial insurers, and state programs.  Interested parties must submit a letter of intent by March 19, 2015.  More information about participation can be found on the Oncology Care Model homepage by clicking here.


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