By Gena Cook, CEO, Navigating Cancer
2016 promises to be a transformative year for cancer care delivery, with the roll out of the Oncology Care Model (OCM). In a few short months, the Center for Medicare and Medicaid Innovation (CMMI) is expected to announce the 100 participants from the pool of OCM applicants that were submitted last June.
What do cancer centers need to understand about OCM now?
OCM is a payment reform model designed to improve episodes of care for patients undergoing chemotherapy. The goal of this payment model is to promote care delivery at the lowest cost, in the most medically-appropriate setting. An OCM episode of care begins with the initiation of chemotherapy treatment and extends over the following six-month period, but one beneficiary may undergo multiple OCM episodes of care during the five-year OCM performance period. Provider participants will consist of physician group practices, as well as practitioners in solo practice. One key feature of OCM is that it places the medical oncologist in the lead role of managing care quality, delivery and cost. In exchange, providers will earn a management fee of $160 per beneficiary per month. That’s $960 per 6-month episode.
In addition, practices will have the potential of earning an average of 12% shared savings through semi-annual performance-based payments – a figure which could amount to $16,000 per beneficiary per year.
Both of these OCM payments are in addition to practices continuing to bill traditional Medicare fee-for-service claims, including reimbursement for Part B drugs administered during OCM episodes at ASP plus a 4% to 6% margin.
While some of the OCM rules and specifications will remain vague pending the official start, here are five over-arching trends we can begin to consider now:
Putting these features in place now won’t just set practices up for success in advance of the inflection point in cancer care delivery that OCM will bring; they will improve experiences, and outcomes, for cancer patients. And that, ultimately, is the point.
You must be logged in to post a comment