The Oncology Care Mannequin is useless. Lengthy Reside the Oncology Care First Mannequin. – Healthcare Economist


The Oncology Care Mannequin is slated to finish quickly. Particularly, the final set of six-month episodes would provoke no later than December 31, 2020 and thus all episodes will probably be accomplished in June 30, 2021. Nonetheless, CMS is proposing a successor to the Oncology Care Mannequin referred to as the Oncology Care First (OCF) Mannequin. CMS describes the revised method as follows:

…the fee mechanisms for the potential OCF Mannequin would come with: (1) A potential, month-to-month inhabitants fee (MPP) for an OCF participant’s assigned inhabitants of Medicare FFS beneficiaries with most cancers or a cancer-related prognosis that would come with fee for Analysis and Administration (E&M) companies, “Enhanced Companies” required beneath the phrases of the mannequin participation settlement, and drug administration companies; and, (2) Complete value of care accountability for Medicare prices, together with drug prices, incurred throughout a six-month episode of care triggered by a Medicare beneficiary’s receipt of a Half B or D chemotherapy drug, 6 with the chance to realize a performance-based fee (PBP) or owe a compensation to CMS (PBP recoupment), relying on high quality efficiency and prices relative to benchmark and goal quantities

What are the variations between OCM and OCF? AJMC studies some key variations:

* CMS desires to shift a number of the FFS fee to capitation, which “will pose challenges for OCF individuals.” Analysis and administration (E/M) companies and drug administration charges, which had been beforehand outdoors the month-to-month apply transformation charge, can be folded inside it.
* Improved performance-based-payment formulation would do a greater job of accommodating quickly rising drug prices and defend oncologists from being held answerable for occasions which might be past their management.
* New necessities could also be added to require practices to collect patient-reported outcomes (PROs).

A Well being Affairs commentary by de Brantes and co-authors is skeptical that OCF will probably be a major enchancment over OCM.

…as we speak’s OCM are fully unpredictable as a result of the precise bills might range from baseline relying on the precise nature of every most cancers handled. Furthermore, in OCF as in OCM, the treating doctor is in danger for whole prices of care, together with companies having nothing to do with most cancers, like care after a automotive accident or for brittle diabetes. Adequately threat adjusting for every most cancers kind and stage throughout all attainable cancers, together with underlying patient-specific traits, appears all however unimaginable.

Analysis by my colleagues Jim Baumgardner and colleagues (Baumgardner et al. 2018) quantifies a number of the variation in value sorts throughout OCM episodes.

Implementation of OCF, nonetheless, has been pushed again as a consequence of COVID-19. The presence of a pandemic makes implementing fee reform problematic. As Lucio Gordan, MD–president and managing doctor at Florida Most cancers Specialists–mentions at AJMC:

However throughout COVID-19, it’s actually a foul time to do new fashions and experimenting or pushing the envelope too fast, too exhausting, as a result of we’re beneath an amazing quantity of stress, and none of us desires to fail and never ship and have penalties by way of 2-sided threat for our practices that might affect entry to care to our sufferers.
For Oncology Care First, I’m completely satisfied that they pushed again 12 months for 2022. We might have extra time, however we’ll see how this performs out.

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