The cancer care model (OCM) is dead. The cancer care model was a voluntary alternative payment model (APM) that “included financial and operational responsibility for treatment episodes associated with the administration of chemotherapy to cancer patients.The OCM expired at the end of June 2022 and will be replaced by Improving the oncology model. The EOM is also a voluntary model that will run for 5 years: from July 2023 to June 2028. [Note: Yes, there is a 1 year gap between the end of OCM and the start of EOM]
Like OCM, EOM allows both oncology group practices (PGPs) and other payers (eg, commercial payers, state Medicaid agencies) to participate in EOM, the latter through multipayer agreements. Like OCM, EOM pays physicians an additional monthly fee for providing coordinated care to their cancer patients. Like OCM, EOM will measure value to cancer patients based on six-month care episodes where the start of chemotherapy (or similar targeted therapy) would be the starting point of the episode. Like OCMs, EOM physicians are eligible for Performance-Based Payback (PBP) based on quality of care and cost savings during these six-month treatment episodes (see below). EOM Newsletter, CMS slides). The method of calculating bonuses and penalties for cost savings is shown in the figures below.
There are seven types of cancer that are included in the EOM. These include the following types of tumors:
- Mammary cancer,
- chronic leukemia,
- Small bowel / colorectal cancer,
- Lungs’ cancer,
- multiple myeloma,
- Prostate cancer
Patients are assigned to PGP based on the proportion of evaluation and management (E&M) services provided between the start of chemotherapy and 6-month episodes. PGP must provide at least 25% of all cancer-related E&M services during an episode to qualify for that episode.
However, unlike the OCM program, EOM’s monthly payments are less generous. Medscape reports that “The CMS Innovation Center plans to cut monthly payments for advanced oncology services at EOM by more than half ($70 vs. $160 for OCM), but at the same time expects more work from practices.” Please note that Dual Eligibles receive an additional MEOS payment of $30 (i.e. $100 in total) per month. Additional work includes collecting additional data such as “electronic patient record (ePRO) collection and screening for social needs that may affect treatment, such as transportation issues and nutritional needs.” While collecting this data is certainly a good thing, it is unclear whether the EOM will provide sufficient funding to health systems to collect this data. In addition, group practices must offer “24/7 physician access and patient navigation services.”
On the positive side, HHS stated that it will “encourage other payers (eg, commercial payers, state Medicaid agencies) to align their core concepts to promote a consistent approach among payers and patients participating in the EOM.” This could reduce the burden on doctors, hospitals and health care systems to deal with different programs for different types of payers.
The quality of medical care will be assessed according to the following parameters:
- Patient experience
- Preventable emergency call
- Treating symptoms of toxicity
- Psychosocial health management
- end-of-life care management