What is the Enhancing Oncology Model (EOM)? – Healthcare Economist

The Oncology Care Mannequin (OCM) is useless. The Oncology Care Mannequin was a voluntary, various cost mannequin (APM), that “included financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients.” OCM expired on the finish of June 2022, and shall be changed by the Enhancing Oncology Model. EOM is a additionally a voluntary mannequin that can run for five years: July 2023 via June 2028.  [Note: Yes, there is a 1 year gap between the end of OCM and the start of EOM]

Like OCM, EOM permits each oncology doctor group practices (PGPs) in addition to different payers (e.g., industrial payers, state Medicaid businesses) to take part in EOM–the latter via multi-payer agreements. Like OCM, underneath EOM physicians are paid an extra month-to-month charge to supply coordinated care to their most cancers sufferers. Like OCM, EOM will measure worth for most cancers sufferers primarily based on six-month episodes of care the place the initiation of chemotherapy (or related focused therapies) would be the initiating level of the episode. Like OCM, EOM physicians are eligible for retrospective performance-based cost (PBP) primarily based on high quality of care and price financial savings throughout these six month episodes of care (see EOM Fact Sheet, CMS slides). The way in which value financial savings bonuses and penalties are calculated are proven within the figures beneath.

There are seven varieties of cancers which are included in EOM. These embody the next tumor varieties:

  • Breast most cancers,
  • Continual leukemia,
  • Small gut/colorectal most cancers,
  • Lung most cancers,
  • Lymphoma,
  • A number of myeloma,
  • Prostate most cancers

Sufferers are attributed to PGP primarily based on primarily based on the share of analysis and administration (E&M) companies supplied between initiating chemotherapy and the 6-month episodes. The PGP should present at the very least 25% of all cancer-related E&M companies throughout the episode to be attributed the episode.

In contrast to the OCM program, nonetheless, the EOM month-to-month funds are much less beneficiant. Medscape reports that “the CMS Innovation Middle plans to chop the Month-to-month Enhanced Oncology Providers funds within the EOM by greater than half ($70 vs $160 for the OCM), however on the identical time, expects extra work from practices.” Word that the dually eligible people get an extra MEOS cost of $30 (i.e., $100 whole) monthly. The extra work contains further knowledge assortment corresponding to “assortment of digital patient-reported outcomes (ePROs), and screening for social wants which will have an effect on remedy, corresponding to transportation points and dietary wants.” Whereas accumulating these knowledge are actually an excellent factor, it’s not clear if EOM will present ample funding for well being techniques to gather these knowledge. Additional, doctor group practices should supply “24/7 entry to a clinician, affected person navigation companies.”

On the constructive aspect, HHS has stated that it’ll “encourage different payers (e.g., industrial payers, state Medicaid businesses) to align with its core ideas to advertise a constant method throughout payers and EOM individuals’ affected person inhabitants.” This might cut back the burden on physicians, hospitals and well being techniques to must take care of completely different packages throughout completely different payer varieties.

High quality of care shall be measured primarily based on the next domains:

  • Affected person expertise
  • Avoidable acute care utilization
  • Administration of signs toxicity
  • Administration of psychosocial well being
  • Administration of end-of-life care

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