Oncology Care Model begins today with 200 practices on board

By John Murphy, MDLinx
Published July 1, 2016

Key Takeaways

Performance-based payments go into effect today, July 1, for nearly 200 group practices participating in the Oncology Care Model, a 5-year demonstration program aimed at improving the quality, coordination, and cost-effectiveness of oncology care, according to the US Department of Health and Human Services (HHS).

In addition to the 196 participating physician group practices—nearly twice the number HHS anticipated—the Oncology Care Model involves 17 health insurance companies and more than 3,200 oncologists to cover approximately 155,000 Medicare beneficiaries nationwide. It runs from July 1, 2016 through June 30, 2021.

“The Oncology Care Model encourages greater collaboration and information sharing so that cancer patients get the care they need,” said HHS Secretary Sylvia M. Burwell. “This patient-centered care model furthers the goal of the Vice President’s Cancer Moonshot to improve coordination, care, and outcomes while spending dollars more wisely.”

The program is using “appropriately aligned financial incentives” that reward practices for high-quality patient care and lowered costs. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, plus a monthly care management payment for each beneficiary.

The Oncology Care Model’s two-sided risk track is considered an Advanced Alternative Payment Model under the newly proposed Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 

Physicians participating in the Oncology Care Model are expected to rely on the most current medical evidence and to inform beneficiaries in order to share decision-making about whether patients should receive chemotherapy treatment, according to the Centers for Medicare & Medicaid Services (CMS).

CMS will track practices’ performance on a number of quality measures and will provide continual feedback to practices during the process. These quality measures will also be used to determine the performance-based payments.

“CMS is thrilled with how many physician groups chose to be a part of the Oncology Care Model,” said Patrick Conway, MD, CMS Principal Deputy Administrator and Chief Medical Officer. “It’s clear that oncology physicians recognize the importance of this new performance-based, episode-based payment approach to cancer care.”

“As a practicing physician and son of a Medicare beneficiary who died from cancer, I know the importance of well-coordinated care focused on the patient’s needs,” he added.

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