By Mary Witt, MSW, Senior Vice President, The Camden Group
In February, the Centers for Medicare and Medicaid Services (“CMS”) announced the Oncology Care Model (“OCM”) Initiative to improve care coordination, appropriateness of care, and access to care for Medicare beneficiaries undergoing chemotherapy by using appropriately aligned financial incentives. The deadline for submitting a non-binding letter of intent (“LOI”) has been extended from April 23 to May 7, 2015. If your oncology practice has not yet considered participating in the OCM initiative, time still remains to consider participation and to submit your LOI.
Participation in the initiative may benefit your practice in the following ways:
- Improves how you deliver care
- Care coordination
- Provides financial resources to strengthen your care delivery model
- Enhances your competitive position in the marketplace by increasing quality and efficiency (cost), (i.e., assist in the creation of a market differentiator)
The OCM Initiative is episode-based, which is defined as chemotherapy and related care during a 6-month period following the initiation of chemotherapy treatment. The goal of the OCM Initiative is to improve quality through transforming how oncology care is delivered in the medical practice setting. Fee-for-service Medicare beneficiaries are automatically enrolled if they receive chemotherapy at a participating practice.
Under the OCM Initiative, participating practices will continue to be paid Medicare fee-for-service payments. Additionally, CMS is implementing a two-part payment approach:
- Per beneficiary per month (“PBPM”)
- Performance-based payment
- Performance on specific quality measures
- Total cost of care as compared to established targets
Eligible practices include:
- Physician group practices and solo physicians providing chemotherapies and currently enrolled in Medicare (multispecialty practices may apply and include only those physicians who furnish cancer chemotherapy).
- Hospital-owned practices may apply as long as the hospital is paid by Medicare under the inpatient and outpatient prospective payment systems.
- Practices that partner with a hospital outpatient department for chemotherapy infusion services may participate as well as those that are owned or affiliated with hospitals that participate in the 340B Drug Pricing Program.
- Practices may participate in other CMS programs including shared savings models such as accountable care organizations. Practitioners participating in the Transforming Clinical Practices Initiative are not eligible to participate.
- Those owned or affiliated with PPS-exempt cancer hospitals, critical access hospitals, Federally Qualified Health Centers, and Rural Health Clinics can’t apply.
For additional information, please download The Camden Group’s new CMS Oncology Care Model Initiative Overview by clicking the button below. This new overview provides the following details of the initiative:
- Eligible Practices
- OCM Practice Requirements
- Financial Incentives
- Risk Factors
- Beneficiary Enrollment and Attribution
- OCM Initiative Benefit to Physician Practices
- Sample Payment Projection
- Timeline for LOI Through Implementation
Ms. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. Ms. Witt leads medical group development, performance improvement, and turnaround projects for integrated delivery systems, medical groups, and academic residency programs throughout the country. She may be reached at email@example.com or 424-201-3971.