In June, the Centers for Medicare & Medicaid Services (CMS) announced the Enhancing Oncology Model, a successor to the Oncology Care Model. The new voluntary model will start in July 2023 and run through 2028. Model participants will include oncology practices that treat people with Medicare undergoing chemotherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.
More on Model
“There are stark inequities in the ability of people with cancer across race, gender, region, and income to access cancer screening, diagnostics, and treatment,” said CMS Administrator Chiquita Brooks-LaSure, “The Enhancing Oncology Model will incentivize participating oncology practices – including those in rural and underserved areas – to improve the provision of high quality, coordinated care that addresses patients’ social needs and improves patient and caregiver support.”
Participants in the model will receive a monthly payment for enhanced services to eligible beneficiaries. Such services include detailed care plans, 24/7 access to an appropriate clinician, navigation services, and screening for health-related social needs such as food, transportation, and housing. Model participants can also collect retrospective performance-based payments according to quality and savings. While practices could get a share of any savings they make as a result of oncology health care transformation, they must repay Medicare for any cost overruns.
Community Oncology Alliance Statement
Ted Okon, Community Oncology Alliance (COA) executive director, noted “At first glance, one significant concern is that CMMI is cutting the Monthly Enhanced Oncology Services (MEOS) payments in the EOM by nearly half of the OCM ($70 in the EOM vs. $160 in the OCM), while expecting more work from practices. COA is extremely supportive of screening for health-related social needs and electronic patient-reported outcomes (ePROs), it seems unfair to burden practices with more work but pay less for it, particularly as practices are dealing with the return of the Medicare sequester cut, inflation, and ongoing COVID-19 practice challenges. We hope to hear more from CMMI about this issue.” In addition, “COA is disappointed that there will remain an unnecessary one-year gap between the OCM ending and EOM beginning. During this time practices will have to shoulder the extensive investments and operational changes put in place to benefit patients without reimbursement.”
Despite the limitations and delayed time frame, Okon stated “Community oncology practices are fully committed to positive, patient-centered improvement of cancer care and look forward to supporting CMMI and practices to make the EOM a success. The goals of the EOM are ones we wholeheartedly support, especially related to improving cancer health equity, electronic patient reported outcomes, enhanced access to cancer screenings, and more.”
Community Support
Tina B Stacy, PharmD, BCOP, Chief Strategy Officer of Clinical Education Alliance, LLC (CEA), affirmed the importance of EOM in making essential cancer care available to all patients. In addition, she noted CEA’s continued commitment to making education, tools, and resources available, including the new model, for the oncology healthcare team in an effort to support oncology health care transformation and improved patient outcomes.
Resources
CMS released a helpful fact sheet on the Enhancing Oncology Model