Will Most Oncology Practices Skip Enhancing Oncology Model?

June 7, 2023
In Community Oncology Alliance survey of independent practices, 71 percent of respondents indicated that they would not be participating in CMMI’s Enhancing Oncology Model

An online survey conducted by the nonprofit Community Oncology Alliance (COA) suggests that the majority of independent oncology practices are not planning to participate in the upcoming Enhancing Oncology Model (EOM) that the Center for Medicare and Medicaid Innovation (CMMI) is about to launch in July.

COA said the survey results raise serious questions about the unpredictability of the model and risks faced by practices.

The COA survey gathered responses from 137 oncology practices across the United States. COA noted that 61 percent (83 practices) of the respondents had participated in the Oncology Care Model (OCM), the previous CMMI oncology payment reform model. The majority of total survey respondents (91 practices or 71 percent of respondents) indicated that they would not be participating in the EOM. Also, 64 percent (88 practices) of the respondents submitted an EOM letter of intent to CMMI; however, only 29 percent (40 practices) actually plan to participate.

The top reasons practices listed as concerns about EOM included immediate entry into two-sided risk arrangements, unpredictability of the EOM and drug prices, and inadequate Monthly Enhanced Oncology Services (MEOS) payments. Without a stable model or the willingness of CMMI to absorb some of the risk while practices get acclimated to participation, in addition to low reimbursement rates, practices indicated they will not take the chance of hurting their operations, according to COA.

The practices that will participate in the EOM (31 percent) indicated that participating in the model positions them for success in other value-based care models from other payers, makes them a leader in payment reform, and provides a framework to provide quality cancer care. They experienced financial success during the OCM and expect the same during the EOM. It gives them a seat at the CMMI table.

Practices that plan to participate and those that do not have both identified several areas where they would like to see improvements made to the EOM. Practices participating in the EOM indicated that they would like to see making two-sided risk optional or phased in, increased transparency around episode target prices, and improved intervals between CMMI feedback reports. Practices not planning to participate indicated that they would like to see increased MEOS payments (to a minimum of $150); allowing the option of one year of one-sided risk; and eliminating the downside risk option.

“Value-based care is the future of healthcare, and community oncology practices are eager to bring the latest and greatest care to their patients,” said Judith Alberto, M.H.A., R.Ph., director of clinical initiatives at COA, in a statement. “However, practices cannot do this when the barrier to entry and cost of participation potentially endangers the quality of care they provide, as well as the future stability of the practice.”

“The COA survey should serve as a red alert to CMS and CMMI that the success of the EOM is at risk,” said Shiela Plasencia, COA director of practice support, in a statement.  “While it is good that some practices are predicting success in the EOM, that is far from certain. Unfortunately, the downside risk to practices, should this model go wrong, is far too great. CMMI must address the concerns of the majority of practices to ensure widespread success.”

The online survey was conducted from May 1 to May 19, 2023, and included 15 questions. 137 practices responded to the survey, with 118 of the respondents being private community practices. Answers were anonymously collected and analyzed by COA’s practice support team.