CMS releases providers, payers taking part in new chemotherapy payment model
A two-part payment approach rewards enhanced services and coordinated care, on top of fee-for-service reimbursement.
The Centers for Medicare and Medicaid Services has released the 196 practices and 17 payers that are participating in a five-year oncology care model that begins July 1.
Under the model, the physician groups - which include those in hospital-based practices - agree to payment arrangements for financial and performance accountability for care surrounding chemotherapy treatment.
The payers, including commercial payers, provide payments for enhanced services and performance; share data with participating practices; and align on core quality measures, CMS said.
The multi-payer model includes Medicare fee-for-service as well as commercial payers that align incentives. It focuses on the care provided during a six-month episode beginning with chemotherapy.
A significant proportion of the more than 1.6 million people diagnosed with cancer each year in the United States are over the age of 65 and receive Medicare.
The practices receive regular Medicare fee for service payments during the model.
There is also a two-part payment approach: a monthly enhanced oncology services payment of $160 per-beneficiary for delivery of oncology enhanced services; and a performance-based payment for oncology care model episodes.
The performance-based payment will be calculated retrospectively on a semi-annual basis based on the practice's achievement on the quality measures and reductions in Medicare expenditures below a target price, CMS said.
The monthly enhanced oncology services payment for enhanced services is intended to give practices the financial resources to effectively manage and coordinate care.
The participating practices have committed to providing enhanced services to Medicare beneficiaries, such as care coordination and navigation, and to using national treatment guidelines for care.
Participating providers also agree to patient access 24 hours a day, seven days a week to an appropriate clinician who has real-time access to practice's medical records; using data to drive continuous quality improvement; and using certified electronic health record technology.
CMS will track performance through clinical improvements, patient health outcomes and care coordination.
When CMS released the value-based model last year, the agency received interest from numerous practices and payers.
[Also: Oncology Care Model lines up more than 400 practices for value-based payment test]
The model includes all Medicare Part A and Part B services and certain Part D expenditures.
Beneficiaries who receive chemotherapy after the end of an episode will begin a new six-month episode, CMS said.
CMS said it would provide opportunities for the payers to convene regularly to share lessons learned on engaging in alternative payment models.
Twitter: @SusanJMorse
