A new payment model targeted at improving Medicare cancer care will begin in mid-2023, the Centers for Medicare and Medicaid Services said Monday.
Known as the Enhancing Oncology Model, the voluntary program builds off the Oncology Care Model, which will end Thursday after six years. Two risk arrangements will be available in the new model, but both will require participants to take on some downside risk.
The Center for Medicare and Medicaid Innovation will launch the new model on July 1, 2023, for a five-year test period.
The Community Oncology Alliance supports the goals of the model and looks forward to making it a success, COA Executive Director Ted Okon said in a news release. But the trade group has some concerns.
"COA is disappointed that there will remain an unnecessary one-year gap between the OCM ending and EOM beginning. During this time practices will have to shoulder the extensive investments and operational changes put in place to benefit patients without reimbursement," Okon said.
Participating physician group practices will be responsible for patient health quality and total spending during six-month episodes of care. Participants can earn a performance-based payment—or owe CMS a performance-based recoupment if total expenditures for attributed episodes go beyond a certain threshold.
Participants will also have the option to bill for a $70-per-beneficiary monthly enhanced payment if extra services including around-the-clock access to a clinician, patient navigation services and social-needs screenings are provided to eligible beneficiaries, according to a CMS news release. CMS said it may require participants to report social-needs screening data in future model years.
CMS will pay an additional $30 per month for dually eligible beneficiaries, though only the base $70 will be included in episode expenditures. The enhanced monthly payment amount is lower than the monthly enhancement available in the Oncology Care Model, but CMS said the new amount is intended to make achieving savings easier. Okon said the alliance is concerned practices will have to take on more work and be paid less under the new system.
Participants also will have to report patient demographic data, including race, ethnicity, language and gender identity. They will have to develop plans for addressing health equity gaps among their patients. CMS will require a gradual implementation of electronic patient reported outcomes as well.
Oncology physician group practices that treat people undergoing chemotherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer and small intestine or colorectal cancer can apply beginning Monday. The application period ends Sept. 30.
Private payers, Medicare Advantage plans and Medicaid agencies can also apply to participate and enter into a memorandum of understanding with CMS. The model will have one track for traditional Medicare enrollees, and another run by payers for their own eligible enrollees.
"There are stark inequities in the ability of people with cancer across race, gender, region, and income to access cancer screening, diagnostics, and treatment," CMS Administrator Chiquita Brooks-LaSure said in the news release. "CMS is working to advance President [Joe] Biden's Cancer Moonshot goals by helping Medicare cancer patients better navigate a challenging and often overwhelming journey."
Biden in February announced an aim to reduce the cancer death rate by 50% in 25 years and improve the lives of people living with cancer.
CMMI in 2019 asked for feedback on a next-generation oncology value-based care model that would have started in 2021 but was never released.
Correction: An earlier version of this story misspelled Ted Okon's name.
