Oncologists worry they may have to reduce staff or enhanced care after payment model ends in June: survey

Oncology practices are trying to figure out their next steps for value-based care as a popular payment model concludes in June with no successor in place, with providers worried that access to services will decline.

Oncologists told a survey conducted by the advocacy group Community Oncology Alliance they are worried that access to care could be reduced without a successor and that staff responsible for navigating value-based care may be laid off.

“Overall, practices indicated that the [Oncology Care Model] transformed the patient experience for the better by comprehensively addressing patient needs and disparities,” said COA in a release on Monday.

The Oncology Care Model started in 2016 and offers oncology practices a way to improve care through an episode-based payment model that pays practices for the total cost of care. Practices could get a monthly enhanced payment for delivering enhanced services like a comprehensive care plan or other patient navigation services.

Commercial payers also agree to participate in the model to create incentives for physicians to transform their care.

As of July 2, there were 126 practices and 5 commercial payers — Aetna, Blue Cross Blue Shield of South Carolina, Cigna, Priority Health and the University of Arizona Health Plan — that were participating in the model.

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But the model is set to expire after this June and the Center for Medicare and Medicaid Innovation has not officially named a successor. While the center floated a potential replacement in 2019 called Oncology Care First, it hasn’t been put in place.

There were 83 practices that responded to COA’s survey, which included questions about the impact of the model on cancer care and if they would continue in the model.

A massive 84% of respondents said they would continue in the model if the financial support of monthly enhanced payments continued. Another 80% said they would participate if the payments were reduced by half and 27% would still participate in the voluntary model even if there weren’t any enhanced payments.

“When asked what impact the end of the [Oncology Care Model] would have on reducing or eliminating certain services, respondents indicated that care planning, survivorship planning and nurse navigators would be most impacted,” according to a report on the survey.

Respondents also commented that they fear staff who have been hired to help with aspects of the care model could be reassigned or lost.

“When specifically asked about the reduction of services after the [Oncology Care Model] conclusion, the average response showed practices reducing key positions like care planner, survivorship planner and nurse navigator by roughly 25%,” the survey said.

Most respondents were also concerned about what the lack of a successor model would mean for value-based care in the future as private payers may also be concerned about participating due to a lack of government support.

CMMI did not immediately return a request for comment on the model.

The center is in the midst of rolling out a strategic refresh of its payment models. A major priority will be streamlining certain models to reduce duplication and make it easier for providers to participate in value-based care.