The Biden administration rolled out a new payment model aimed at improving equity and care coordination for cancer treatments.
The Centers for Medicare & Medicaid Services (CMS) announced Monday the Enhancing Oncology Model, a successor to the Oncology Care Model that ends in a few days. The new voluntary model will start in July 2023 and run through 2028.
“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 in a statement Monday.
She added that the model will incentivize oncology practices to “improve the provision of high quality, coordinated care that addresses patients’ social needs and improves patient and caregiver support.”
Participants in the model can also get a monthly payment for enhanced services to eligible beneficiaries. Such services include detailed care plans, 24/7 access to an appropriate clinician and navigation services like getting access to clinical trials.
Model participants can also get retrospective performance-based payments according to quality and savings. But they must take on downside risk from the start of the model. The practices could get a share of any savings they make but must also repay Medicare for any cost overruns.
The model will also focus on beneficiaries that are “getting systemic chemotherapy for seven cancer types: breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma and prostate cancer,” according to a fact sheet on the model.
A key requirement of the new model is for oncology practices to screen participants for health-related social needs. Practices that offer enhanced services when patients qualify for both Medicare and Medicaid will get an additional payment.
Practices must also report patient demographics such as race and ethnicity and create an equity plan to close gaps in care among their patients.
The equity provisions are part of a larger effort by the Biden administration to address health equity in payment models. A similar equity plan requirement is included in the ACO REACH model announced earlier this year that offers partially capitated payments to physicians.
Oncology practices that want to apply for the model have until Sept. 30 to submit their applications.
The initial reaction from oncology practices was mixed.
The Community Oncology Alliance (COA), which represents independent oncology practices, said in a statement that it was happy to see a successor to the Oncology Care Model that expires after this month.
But COA was concerned that the Center for Medicare and Medicaid Innovation is cutting the monthly enhanced services payments in the new model by nearly half compared with the Oncology Care Model, with $70 for the new model and $160 in the previous model.
While COA was extremely supportive of the screening for health-related social needs, it is “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,” the group said in a statement.
The group was also disappointed there will be a one-year gap from the end of the current model and the start of the new one.
“During this time practices will have to shoulder the extensive investments and operational changes put in place to benefit patients without reimbursement,” the group added.