Cancer organizations express mixed reactions to Enhancing Oncology Model

A new voluntary oncology payment model the Biden administration announced earlier this summer has been met with support, as well as concerns, from several cancer organizations.

The multipayer Enhancing Oncology Model, designed by the Center for Medicare and Medicaid Innovation (CMMI) within CMS, will be the successor to the Oncology Care Model (OCM), which was CMS’s initial effort at value-based care delivery. Although the OCM expired June 30, the EOM will not begin until July 2023.

Cancer organizations have expressed enthusiasm for the new model but also voiced concerns about the significant reduction in Monthly Enhanced Oncology Services (MEOS) payments — under the new model, payments will be $70, a decrease from the $160 MEOS payments under the OCM.

“At first glance, one significant concern is that CMMI is cutting MEOS payments in the EOM by nearly half of the OCM, while expecting more work from practices,” Ted Okon, MBA, executive director of Community Oncology Alliance, said in a statement. “COA is extremely supportive of screening for health-related social needs and electronic patient-reported outcomes; it seems unfair to burden practices with more work but less pay for it, particularly as practices are dealing with the return of the Medicare sequester cut, inflation and ongoing COVID-19 practice challenges.”

Goals of the EOM

Through the EOM, participating oncology practices will accept financial and performance accountability for services around systemic chemotherapy administration to patients with breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma and prostate cancer. EOM participants will assume responsibility for the total cost of care during a 6-month episode of care and will choose one of two financial risk arrangements with differing levels of downside risk. Both EOM risk arrangements will likely qualify as Merit-based Incentive Payment System (MIPS) Alternative Payment Models (APMs) under the Quality Payment Program.

EOM is designed to better support patients through comprehensive, coordinated cancer care; data-driven continuous improvement; payment incentives, including a MEOS payment and a performance-based payment or performance-based recoupment; an aligned multipayer structure; and concerted efforts to identify and rectify health disparities.

As part of quality improvement data reporting, EOM participants will also present health equity plans to CMS and detail evidence-based strategies to reduce health disparities identified within their beneficiary populations.

“There are stark inequities in the ability of people with cancer across race, gender, religion and income to access cancer screening, diagnostics and treatment,” CMS Administrator Chiquita Brooks-LaSure said in a press release. “CMS is working to advance President Biden’s Cancer Moonshot goals by helping Medicare [patients with cancer] better navigate a challenging and often overwhelming journey.”

Responses from oncology groups

Oncology societies, such as ASCO, issued statements praising the voluntary model but expressing some concerns.

“ASCO is pleased that CMMI is proposing EOM as a voluntary model and that practices will be able to choose to participate based on their level of readiness and ability to assume financial risk,” ASCO said in a press release. “We also fully support CMMI’s focus on equity and coordinated cancer care. However, we are concerned that CMMI has proposed a sizable reduction in MEOS payments compared to similar payments in the OCM. This is especially concerning given that there will be a gap of a year between the end of OCM and the start of EOM, during which time practices will receive no additional support for the mechanisms instituted during OCM to enhance patient access and care coordination that will continue under EOM.”

The Association of Community Cancer Centers also expressed cautious optimism regarding the new model.

“ACCC appreciates that CMS has made participation in EOM voluntary, and that the agency has taken feedback from ACCC and its members participating in OCM to make improvements to the price prediction models and attribution methodology for this new model,” the organization said in a statement. “We also applaud the model’s focus on improving health equity by requiring participants to implement new redesign activities, such as screening patients for social needs and developing health equity plans to mitigate disparities within their own patient populations.”

The ACCC echoed ASCO’s concerns about some of the structural components of the new model. It cited the requirement for participants to accept downside risk from the start of enrollment, noting that this could pose a significant barrier given the current reimbursement landscape.

“Two-sided risk models may not make financial sense for smaller oncology programs, particularly those who care for underserved patients and those that have not previously participated in OCM,” the association stated. “CMS should endeavor to provide as much information on proposed payment methodologies, cost data and benchmark amounts as early as possible so that practices can make informed decisions around participation.”

Reference s :

Biden administration announces new model to improve cancer care for Medicare patients (press release). Available at: www.hhs.gov/about/news/2022/06/27/biden-administration-announces-new-model-to-improve-cancer-care-for-medicare-patients.html. Published June 27, 2022. Accessed Aug. 3, 2022.

Medicare Innovation Center announces new oncology payment model (press release). Available at: www.asco.org/news-initiatives/policy-news-analysis/medicare-innovation-center-announces-new-oncology-payment. Published June 27, 2022. Accessed Aug. 3, 2022.

ACCC statement on the Enhancing Oncology Model (press release). Available at: www.accc-cancer.org/home/news-media/news-releases/news-template/2022/06/29/accc-statement-on-the-enhancing-oncology-model. Published June 29, 2022. Accessed Aug. 3, 2022.

Community Oncology Alliance statement on the Enhancing Oncology Model (press release). Available at: communityoncology.org/reports-and-publications/press-releases-media-statements/statement-enhancing-oncology-model/. Published June 29, 2022. Accessed Aug. 3, 2022.