ASCO Expresses Concern Over the New CMS Oncology Care Model
On Thursday, February 12, 2015, the U.S. Department of Health and Human Services announced its new Oncology Care Model, a multipayer payment and care delivery model meant to support better health-care coordination for patients with cancer. Although commending the Centers for Medicare & Medicaid Services (CMS) for seeking new approaches to physician payment, in a news release, ASCO expressed concern that the model “continues to rely on a broken fee-for-service system.”
CMS Oncology Care Model
According to the CMS press release, the new Oncology Care Model will improve the quality of care patients with cancer receive and lower health-care costs through “episode-based, performance-based payments that financially incentivize high-quality coordinated care.” The Oncology Care Model initiative includes 24-hour access to physicians for beneficiaries undergoing cancer treatment and is based on coordinated, person-centered care, aimed at rewarding value of care, rather than volume.
The model focuses on three key areas:
- Linking payment to quality of care
- Improving and innovating care delivery
- Sharing information more broadly to providers, consumers, and others to support better decision while maintaining privacy
“With the Oncology Care Model, CMS has the opportunity to achieve three goals in the care of this medically complex population who are facing a cancer diagnosis: better care, smarter spending, and healthier people,” said Patrick Conway, MD, Chief Medical Officer and Deputy Administrator for Innovation and Quality at CMS, in a statement. “As a practicing physician and son of a Medicare beneficiary who died of cancer, I know the importance of well-coordinated care focused on the patient’s needs.”
ASCO Proposes Payment Reform to Support Patient-Centered Care
In response to the Oncology Care Model announcement, Richard Schilsky, MD, FACP, FASCO, ASCO’s Chief Medical Officer, said, “We are disappointed [CMS has] chosen to pursue only one model—and one that continues to rely on a broken fee-for-service system.”
According to ASCO’s statement on Oncology Care Model, the Society submitted comments to CMS on a draft version of the new model and supported testing Oncology Care Model as well as other payment reform models, which include more fundamental reform that moves away from the fee-for-service system. “ASCO looks forward to working with both public and private payers to explore new payment strategies that better reflect oncology practice and support high-value, patient-centered care,” said Dr. Schilsky.
In May 2014, ASCO released its Consolidated Payments for Oncology: Payment Reform to Support Patient-Centered Care for Cancer, which outlines a new approach to physician payment for cancer care services under Medicare. ASCO’s model calls for five types of flexible, bundled payments designed to cover currently uncompensated time and costs as well as many of the services that are currently reimbursed, including separate payments for tests and major procedures oncology practices perform and reimbursement for the costs of purchasing and storing drugs the practice administers in the office.
The five types of bundled payments oncology practices would receive under ASCO’s model include:
- New Patient Payment—This payment would be much larger than practices receive today for initial office visits to reflect the extensive, uncompensated time oncologists spend developing treatment plans and doing patient education and counseling.
- Treatment Month Payment—The practice would receive this payment during each month the patient is being treated regardless of whether the drugs are oral or parenteral. A practice would receive one of four levels of payment each month, with higher payments to cover the additional costs of treating patients with multiple health problems and/or poor performance status and for patients receiving more toxic and complex drug regimens.
- Active Monitoring Month Payment—In this case, the oncology practice would receive payment during months when the patient is not being actively treated with medications but is still receiving care and support from the practice, including testing and monitoring for recurrences or cancer progression.
- Transition of Treatment Payment—The oncology practice would receive an additional payment during months when the patient’s disease progressed or recurred or when significant treatment regimen changes were needed, reflecting the significant additional time needed for treatment planning and patient education.
- Clinical Trial Payment—This payment would provide the practice with an additional monthly payment for each patient participating in a clinical trial. Currently, lack of payment to cover the significant time and costs associated with trials discourages many practices from participating in clinical trials.
According to ASCO’s press release, the Society shared its proposal with CMS and private insurance companies and is also working on piloting the proposal in different oncology settings across the country.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
