Oncology Care Model Update—Stakeholders’ Perspectives

Last week – on Thursday, May 3, 2018 –  Oncology Care Model (OCM)-participating practices from across the country traveled to the Center for Medicare & Medicaid Services (CMS) offices in Baltimore, Md., for the annual OCM Stakeholder Meeting. The public forum was hosted by a panel of representatives from the Center for Medicare and Medicaid Innovation (CMMI), including Lara Strawbridge, OCM Model Lead; Dr. Ron Kline, Clinical Lead for OCM; and Ellen Lukens, Division Director, Specialty Payment Models at CMMI.

This public stakeholder meeting follows the February 2018 release of OCM participants’ reconciliation reports. These reports were highly anticipated by OCM practices because, for the first time, they would be made aware of their historical benchmarks and target prices to achieve savings within the model. Put simply: Release of these reconciliation reports provided OCM practices with a reality-check on how they are performing in the model.

For some, the reconciliation reports were an affirmation; for others, a cause for consternation. A CMS report states that while only 25 percent of participating practices were able to achieve a Performance-Based Payment (PBP), 50 percent of practices have begun to achieve some sort of savings in the model. OCM practices have until the beginning of performance period 7 (July 2019) to demonstrate savings in the model to assume more than nominal risk, i.e., two-sided risk, or be forced to exit the model.

In March, shortly after release of the first reconciliation reports, ACCC hosted its bi-annual ACCC OCM Collaboration Workshop, bringing OCM participating participants together to share successes and challenges. While reconciliation reports were a repeated theme of discussion, OCM practices described how they’ve made headway in practice transformation—with some hurdles overcome and some challenges that continue. Many of the successes and pain points raised by ACCC OCM Collaborative Workshop participants were also discussed in-depth last week during the CMMI OCM Stakeholder Meeting in Baltimore.

Stakeholder Concerns

During the three-hour CMMI OCM public forum OCM practices and other model-participant stakeholders commented on model methodology, including OCM Beneficiary Attribution, Performance-Based Payment Methodology, drug costs, and electronic health records (EHR) pain points.

Stakeholders repeatedly expressed concern over the impact of high drug costs on practice performance within the model. OCM practices attending the forum in person took the time to voice their concern over the trend factor methodology and novel therapy adjustment. Several stakeholders stated that, were it not for rising drug costs, they estimate that they would have satisfied the performance metrics for the previous performance period.

Another re-occurring theme was the difficulties associated with electronic health records (EHRs), including EHR-vendor delays and challenges in getting the providers to use EHRs to capture appropriate quality data. CMMI also noted the frustration that many OCM practices have experienced with beneficiary attribution and associated issues with payment methodology and recoupment. In direct response to advocacy efforts from many OCM practices and associated provider groups, the OCM practices eligible for OCM beneficiary attribution include any Tax Identification Number (TIN) on their claim that has at least one oncologist billing during the performance period.

At the conclusion of the three-hour stakeholder meeting, the CMMI OCM team stated that stakeholders who were unable to join in the May 3 CMMI OCM Public Forum can still submit comments to the OCM by email to OCMSupport@CMS.hhs.gov.

In an effort to be more transparent regarding summary data of OCM practices participation, the CMMI OCM team announced the release of an aggregate report in late 2018 that will detail a summary of all OCM practice evaluations since the model’s beginning. While the summary report will not include practice-specific data, the CMMI OCM team stated that this report will be a way to generate an aggregate of OCM practice participation as well as best practices and lessons learned.

ACCC is committed to continuing to support participating OCM practices through our ACCC OCM Collaborative activities. In case you missed our March 2018 workshop in Washington, D.C., please look out for an email about our ACCC OCM Collaborative “In Case You Missed It Webinar Series” where we will be speaking one-on-one with some of our most recent workshop presenters to follow-up on their successful OCM implementation efforts.

Don’t Forget! - Mark your calendars for October 16-17, 2018, in Phoenix, Arizona, for our sixth bi-annual ACCC OCM Collaborative Workshop in conjunction with the ACCC 35^th National Oncology Conference. For more information and to register, click here, or contact the ACCC OCM Collaborative Project Lead, Blair Burnett, at bburnett@accc-cancer.org.