03/16/2015

CMS Innovation Center Oncology Care Model Resources/Webinars

There are many opportunities for MSHO members to learn about the new CMS Oncology Care Model. Following are links to offerings and information from CMS, ASH, ASCO, and ACCC. 

MSHO will continually update our website with the latest educational offerings on this topic.

On February 12, the CMS Innovation Center (CMMI) released its much-anticipated Oncology Care Model (OCM) as part of the broader effort to lower healthcare costs and tie reimbursement to quality and value. 

The OCM looks similar to a patient-centered oncology medical home or accountable care organization (ACO), with a target expenditure and shared savings component that encompasses the total cost of patient care during a particular period of treatment. The model is a voluntary, five-year program slated to begin in spring 2016. Physician group practices, hospital-based practices (except for PPS-exempt hospitals), and solo practitioners that furnish cancer chemotherapy are eligible to participate. Payments will be based on a six-month episode of chemotherapy treatment that is triggered by the administration of a pre-set list of chemotherapy drugs, and will take into account all Part A, Part B, and some Part D expenditures for that patient during the episode. In addition to a FFS payment, providers will receive a care coordination payment to improve quality of care ($160 per patient, per month during the episode) and a performance-based payment to incentivize lower costs that will be based on the difference between a risk-adjusted target price and actual expenditures during the episode. The payment arrangement is one-sided risk, with the option of converting to two-sided risk in the third year.

Payer Letters of Intent (LOIs):

The list of payers that submitted LOIs to participate in OCM is now available on the OCM website at http://innovation.cms.gov/initiatives/Oncology-Care/. The list includes the names, locations, and points of contact for the forty-six payers that submitted LOIs and agreed to public posting. 

Practices in the same markets as payers that submitted LOIs are strongly encouraged to engage with those payers during the coming weeks to coordinate participation in OCM. 

Practice LOIs:

Practice LOIs are due to CMS by 5pm EDT on May 7, 2015.  The LOI document must be downloaded from the OCM website and emailed to OncologyCareModel@cms.hhs.gov.  The list of practices that submit LOIs and agree to public posting will be available on the OCM website on May 14, 2015. 

Upcoming Webinar -- Frequently Asked Questions (FAQs) and Application Instructions:

The OCM team will host a webinar on Wednesday, April 22, 2015 from 12:00 – 1:00 pm EDT that addresses model FAQs and an overview of the web-based application. More information, including instructions on how to join the event online or by phone, is available on the webinar website.  The webinar is open to the public; no password or advance registration is required. 

Updated Model Materials:

The model’s Request for Applications (RFA) and FAQs documents have been recently updated, and are currently posted on the OCM website.  Applicants are encouraged to review these updated documents carefully. 

If you have questions, please contact us at  OncologyCareModel@cms.hhs.gov.  

ASH Oncology Care Model Analysis

Click here to read ASH’s analysis of the model.

ASCO Payment Reform Educational Series

This five-part ASCO in Action educational series is designed to help ASCO members better understand the complex issue of physician payment reform:  Part 1 provides an overview of the issue; Part 2 discusses the Sustainable Growth Rate formula; Part 3 provides details on the current buy and bill system of reimbursing for oncology drugs; Part 4 discusses payment reform options being considered as alternatives to the current fee-for-service system and calls to action; and Part 5 presents a proposal for patient-centered reform through an episodic approach to oncology care. 

• Oncology Practice: Front and Center in National Payment Reform Debate
• The Sustainable Growth Rate Formula, An Outdated Prescription for Medicare Payment
• Physician Administered Drugs: The Evolution of Buy and Bill
• Oncology Payment Options
• A Proposal for Patient-Centered Payment Reform: An Episodic Approach to Oncology Care  

http://www.asco.org/advocacy/physician-payment-reform

Association of Community Cancer Centers

http://www.accc-cancer.org/mediaroom/Newsfeed.asp#sthash.Q9YnqXcw.dpuf