Tag Archives: Oncology Care Model (OCM)

OCM Evolving Best Practices: Lessons to Date

By Monique J. Marino, Senior Manager, Publications & Content, ACCC

ThinkstockPhotos-507273299Last June, the Centers for Medicare & Medicaid Services (CMS) announced that nearly 200 physician group practices and 17 health insurance companies had been selected to participate in the Oncology Care Model (OCM), the first oncology-specific alternative payment model (APM) pilot. (According to the latest information on the OCM website, participant numbers now stand at 190 practices and 16 payers.)  At about 7 months into this brave new world, participants are beginning to share some lesson learned. At last week’s Cancer Center Business Summit in Las Vegas, a panel discussion on The Oncology Care Model: Evolving Best Practices, shed light on some of the challenges participants have experienced to date with the Center for Medicare and Medicaid Innovation (CMMI) model.

Panelist Diana Verrilli, Senior Vice President, Payer and Practice Management Solutions, McKesson Specialty Health, described the OCM as a “thoughtful and comprehensive model that is changing how people are being treated at our practices every day.” With 14 US Oncology practices—about 800 physicians—participating in the OCM, Verrilli shared three tangible outcomes that participants hope to see come out of the program: 1) a change in physician behavior, 2) improved use of clinical pathways, and 3) better patient outcomes, such as helping patients avoid hospitalizations.

OCM-related challenges that US Oncology practices have faced to date include:

  1. Developing processes to easily identify patients on oral oncolytics.
  2. Finding the resources and time required for practice transformation, for example, OCM participants are finding completion of the IOM care plan to be both time and staff intensive.
  3. Developing the complex care partnerships and pooling arrangements necessary to succeed under the OCM, e.g., adequate physician compensation.
  4. Creating processes and tools to needed to meet data submission and reporting requirements.

“If I could change one thing about the OCM,” Verrilli ended. “It would be to reduce the number of quality measures and the amount of documentation that is required.”

Fifty-five Flatiron practices across 20 states are also participating in the OCM. According to panelist Brenton Fargnoli, MD, Associate Medical Director Strategic Initiatives, Flatiron Health, challenges facing these practices relate to:

  1. Care management. How do you identify eligible patients? Keep track of data? Inform patients about their care plans—engaging and educating patients in their care.
  2. Program evaluation and reporting. How do you measure quality? Improve practice performance? Report to the OCM registry in the most cost-effective and efficient way possible?
  3. Revenue cycle management. How do you optimize practice income in the OCM model?

To meet these challenges, Flatiron is working with its practices to develop turnkey solutions, such as:

  1. Care management. Development of an e-process to do patient identification at point of care; Auto-generation of the IOM Care Plans in the EHR.
  2. Program evaluation and reporting. Structured data capture in the EHR; Auto-generation of an OCM Quality Measures Dashboard and OCM Registry reporting requirements.
  3. Revenue cycle management. Implementation of MEOS billing and collections tracking; Cost of care analytics.

When asked how the OCM could be improved, Dr. Fargnoli expressed sentiments similar to Verilli’s, “What’s working? Practices are very engaged and want to see the OCM model succeed. What’s not working as well—OCM rules and requirements are so complex that the majority of provider time is being spent on these documentation and reporting requirements.”

Finally, panelist Barbara McAneny, MD, Chief Executive Officer, New Mexico Oncology Hematology Consultants, shared concerns about the performance targets under the OCM, “If I could change one thing about the OCM, it would be the methodology by which the agency calculates targets so that practices can actually hit them. So how can CMS refine its targets? Give providers a year to collect the clinical data so that we can figure out why some patients are more expensive to treat than others. Using these data, we can work together to better refine OCM targets.”

For OCM participants interested in expanding the conversation, on Friday, March 31, 2017, ACCC is hosting the ACCC Oncology Care Model (OCM) Collaborative Workshop at the Renaissance Washington, DC, Downtown Hotel. Exclusively for OCM participants, the one-day event offers valuable, peer-to-peer learning with like-minded OCM professionals. The workshop will include snapshot presentations from OCM practices with innovative ideas and solutions for meeting OCM requirements, workgroups on hot topics, and a facilitated Q&A session. See registration details below.


The March 31, ACCC OCM Collaborative Workshop is an exclusive event for providers participating in the OCM. All attendees must pre-register for the OCM Collaborative Workshop through the CANCERSCAPE registration portal. To register, select the one-day OCM Workshop during registration checkout. Only those who are pre-registered for this workshop will be admitted. REGISTER TODAY.

Learn more about the ACCC OCM Collaborative here. This invitation-only platform provides a targeted discussion board and access to OCM-focused events. If your program is participating in the OCM and you have not received an invitation to join the ACCC OCM Collaborative, please fill out the form on the Collaborative Homepage to gain access to this peer-to-peer learning resource.

Medicare Oncology Care Model: Opportunities for Social Work Participation

By Fran Becker, LCSW, OSW-C

ThinkstockPhotos-467463476The oncology community continues to follow developments with the Center for Medicare and Medicaid Innovation (CMMI) Oncology Care Model (OCM), a program that aims to improve patient care, efficiency, effectiveness, and lower costs.

As participating cancer programs implement the changes mandated by the OCM, increased responsibilities for social work are clear.  In fact, under the model, the involvement of, and coordination with, social work is needed in a number of areas.

The OCM mandates that all patients receive patient navigation and supportive services during their treatment. These services encompass assistance in a number of areas, including financial, transportation, and facilitation of follow-up services.

As a component of the OCM, Medicare is requiring the documentation of a comprehensive Care Management Plan described in the National Academies (formerly, known as the Institute of Medicine) report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. All patients are to receive a care plan consisting of 13 items.  Among these, there are two areas that call for social work services:

Advance Care Plans – Social work has been involved in these conversations for some time in many settings. In fact, Medicare has revised payment policies to include advance care planning (CPT code 99497; add-on CPT code 99498). While the physician is the primary provider in advance care planning conversations, members of the cancer care team, including social work and other allied healthcare professionals, have an opportunity to be involved in these conversations

Distress Screening – Another important requirement under the OCM is screening for depression during each episode of care. As part of the patient’s care plan, OCM participants are required to screen and document a plan to address a patient’s psychosocial health needs. While many cancer programs screen for distress using the NCCN Distress Thermometer, Medicare has determined that this tool is not sufficient to screen for depression under the OCM, and asks OCM participants to use the PHQ-2 and PHQ-9 for depression screening.  The PHQ-2 self-report asks two questions to determine if a more extensive evaluation is needed.  If the patient scores at a three or above, the patient is asked to complete the lengthier PHQ-9.  During this meeting, if the patient screens in for depression, social work involvement escalates.  Social work has several options for helping patients, including offering counseling services in-house or referral to an outside agency, referral to the patient’s primary care provider, oncologist, or a psychiatrist. Even if the program is providing clinical social work services, follow-up on these referrals is needed to ensure patients follow through. In addition, social work is required to follow the patient to assess improvement or the need for additional services.

Social workers play an important role in helping OCM participating programs succeed under this innovative new model. Practices that are not participating in the OCM should do a self-assessment in terms of their social work capabilities, and their ability to support patients’ psychosocial health needs. As signaled through CMMI’s inclusion of social work and patient navigation services in the OCM model, this holistic approach to cancer treatment is sure to be the future of oncology care.

If you are a participating OCM practice, be sure to join ACCC’s OCM Collaborative, an online community of OCM practices sharing best practices, tools, and tips to succeed in the OCM. Join today.


Guest blogger Fran Becker, LCSW, OSW-C, is manager of Cancer Support Services, Carl & Dorothy Bennett Cancer Center, Stamford Hospital, and a past member of the ACCC Board of Trustees.

With Final MACRA Rule, CMS Increases Flexibility

By Leah Ralph, Director of Health Policy, ACCC

Healthcare costsOn Friday, October 14, the Centers for Medicare & Medicaid Services (CMS) released its final rule on the MACRA Quality Payment Program (QPP).  ACCC is conducting an in-depth analysis of the rule; however, an initial look reveals that CMS has heard the stakeholders’ message  loud and clear: Make the transition to MACRA as simple and flexible as possible. Here are some top-level highlights from the final rule:

  • Low-volume threshold exemption: the agency broadened the low-volume threshold exemption from the Merit-Based Incentive Payment System (MIPS), exempting practices with less than $30,000 in Medicare charges or fewer than 100 unique Medicare patients per year. This will exclude about one-third of physicians from having to report under the Quality Payment Program (QPP).
  • Pick your pace: CMS is allowing physicians to “pick their pace” in 2017, enabling physicians to avoid negative penalties in 2019 by reporting on some data (i.e., one quality measure) for some period of time. The takeaway: even minimal performance reporting will exempt physicians from any penalties, and opportunities for a shorter, 90-day reporting period will make providers eligible for positive adjustments. (Providers must start collecting data between January 1, 2017, and October  2, 2017, and report no later than March 31, 2018.)
  • Resource use category weighted zero in first year: MIPS has four components, and originally the resource use (cost) category was going to account for 10% of your score starting in 2017. CMS has now said this category will hold zero percent weight toward your MIPS score in the first year [in 2017, the percentages will be: 60% quality measures, 25% advancing care information (EHR use), and 15% clinical improvement activities].
  • Expanding opportunities to participate in APMs: CMS has also said it plans to expand opportunities to participate in models that qualify as “advanced alternative payment models” (APMs) in 2017 and 2018. The Center for Medicare and Medicaid Innovation (CMMI) also informed Oncology Care Model (OCM) practices on Friday, October 14, that CMS is amending the program to allow OCM practices to take two-sided risk as early as January 2017 to qualify as an advanced APM (two years earlier than the model originally allowed).

In our comments on the proposed rule, ACCC asked for increased flexibility for practices who are still building the infrastructure to meet these requirements, and a streamlining of reporting requirements as our members increasingly engage in new delivery models and navigate the path to value-based care. ACCC’s major concerns were around timeline and administrative burden – in the final rule, CMS was responsive in many ways, but ACCC will continue to work with the agency to reduce regulatory burden and make this a workable payment system for our members.

For more information, CMS launched a website for physicians that explains the program and allows you to explore and identify different measures that are most meaningful to your practice. Find a summary of the rule here. The AMA and ASCO also have great checklists on how to prepare for participation in the QPP.