The oncology groups still participating in the Oncology Care Model (OCM) of value-based payment are disappointed that the Center for Medicare and Medicaid Innovation (CMMI) has not revealed plans for a successor model for after the OCM expires in June 2022. The model was scheduled to expire in 2021, but was extended due to the pandemic.
The nonprofit Community Oncology Alliance (COA) is urging CMMI not to slow the momentum of the OCM. COA launched a major support initiative effort behind the OCM when it first started in 2016, offering free tools, resources, and knowledge to practices implementing the OCM.
“Practices have poured time and resources into this important project with a clear benefit to patients,” said COA President Kashyap Patel, M.D. in a statement. “CMMI should be thinking of ways to use the lessons learned from the OCM going forward, not ending it without a plan for the future," added Patel, who also is CEO of OCM practice Carolina Blood and Cancer Care Associates in Rock Hill, S.C.
CMS’ most recent evaluation of the OCM Model found that it reduced total episode payments relative to comparison episodes. After including payments made to practices under the model, however, OCM resulted in net losses to Medicare totaling $377.1 million over five performance periods.
In late 2019, CMMI previewed the successor model to the OCM, known as the Oncology Care First (OCF) Model, which it said would be built on lessons learned from the OCM Model. COA said it is unknown what the status of the OCF is, and the OCM is concluding without a successor model and no communication about the future. COA said there will be a void in leadership if CMMI steps away from this work in oncology.
To assess the impact of the OCM, COA conducted a survey of member practices. With the OCM scheduled to end on June 30, 2022, COA wanted to understand how practices have been affected by the OCM, both positively and negatively, and how the end of the OCM and accompanying Monthly Enhanced Oncology Services (MEOS) reimbursement might change practice operations.
As of July 2, 2021, 126 practices were participating in the OCM. Of those practices, 83 responded to the survey, of which 78 had participated in the OCM and 73 are still participating. This report reflects the feedback of the 51 that completed the entire survey. The average respondent employed 41 MDs and 178 full-time equivalent physicians at an average of 12 locations.
Respondents were asked to rate, using a scale of 0-100 (0 – No impact, 100 – Tremendous impact), the impact of the OCM on five categories: Patient Experience, Operational Efficiencies, Consistency on Cancer Treatments, Reduced Total Cost of Care, and Addressing Health Disparities. The responses indicate positive effects stemming from the OCM:
• Patient Experience: 62
• Operational Efficiencies: 56
• Consistency on Cancer Treatments: 56
• Reduced Total Cost of Care: 49
• Addressing Health Disparities: 45
Overall, practices indicated that the OCM transformed the patient experience for the better by comprehensively addressing patient needs and disparities. Survey respondents also expressed disappointment that CMS was not continuing the OCM or providing plans for a successor model.
Practices were asked if they would continue in the OCM if financial support in the form of MEOS payments were reduced or eliminated:
• 84 percent said yes, as it is currently operating, with full MEOS payments.
• 80 percent said yes, even if MEOS payments were reduced by half.
• 27 percent were willing to continue without any MEOS payments.
When asked what impact the end of the OCM would have on reducing or eliminating certain services, respondents indicated that care planning, survivorship planning, and nurse navigators would be most impacted.
Many survey respondents indicated that the OCM helped practices integrate patient perspectives and mitigate external factors like financial or social toxicities. Many revealed a fear that staff now considered an essential part of the care routine would be reassigned or lost.
When specifically asked about the reduction of services after the OCM conclusion, the average response showed practices reducing key positions like care planner, survivorship planner, and nurse navigator by roughly 25 percent.
Participants were also asked to indicate how the OCM has influenced, or will influence, past, present, and future value-based care. The majority of respondents indicated a worry that the lack of a successor model would delay future models or cause private payers to avoid creating new models over lack of government support.
