Proposed Change for Oncologists a Step Toward Bundled Payments

Leaders from a growing network of community oncology practices say a proposal for the next phase of payment reform would represent a major shift in the way Medicare pays for medical oncology.

Authors from OneOncology, writing this week in JCO Oncology Practice, warned about the consequences of Oncology Care First (OCF), which the Center for Medicare and Medicaid Innovation described in an informal request for information late last year.

OCF is scheduled to replace the current Oncology Care Model next year with something that is an “intermediate step to a true bundled payment in medical oncology,” they said.

OCM combines fee-for-service payment model with a “monthly enhanced oncology services”-or MEOS-payment to cover “practice transformation” services, which include care coordination and survivorship care. It also has performance-based payments based on financial and quality metrics.

Under the next phase of reform, the authors say, the OCF model would fold even more items under the monthly per-patient fee, including core services such as evaluation and management services and drug administration.

“These proposed changes not only represent a near-term progression toward the CMS’ goal to augment its value-based payment models for cancer, they also provide signals on how CMMI may view the future of value-based care in oncology,” the authors write.

The proposed new model may also require practices to track patient-reported outcomes, perhaps with digital tools. The Community Oncology Alliance has asked CMMI to phase in this requirement, so practices do not have to absorb the cost in a single year. The alliance has also asked that the new model not be stared until January 2022.

On the plus side, the new model changes performance-based payment formulas to account for difference by cancer type. The authors see protections for physicians from factors that are beyond their control involving long-term patients receiving most of their care from a primary care physician.