Medical Billing Outsourcing

Oncology Care Model

The Centers for Medicare & Medicaid Services recently announced that 196 practices would be participating in their proposed Oncology Care Model (OCM). CMS says that OCM is designed to decrease the expenditure for oncology without compromising on quality of care. In view of that, Sylvia M. Burwell, Secretary of Health and Human Services said “…the Oncology Care Model encourages greater collaboration and information sharing so that cancer patients get the care they need.”

According to the National Institutes of Health, cancer costs will increase by 27% from 2010 to 2020. OCM splits the practice payment into 6 months episodes from the beginning of chemotherapy. The plan allows a monthly payment of $160 per patient, which CMS expects to promote “timely, coordinated treatment.”

Under OCM, practices are required to coordinate patient care and diagnostics with other physicians, as well as provide clinical trials, pain management services, emotional support groups, and reduce the number of patient visits by accessing the test data before the visit. The model also mandates healthcare providers to offer round the clock care for patients and strictly follow treatment guidelines.

Nonetheless, some practice administrators have mixed feelings in joining in the OCM. They want to cooperate with the new system but it seems very complex. Some providers said that CMS has not given enough details, and the data requirements for performance measurement are hard to accomplish.

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Healthcare Advancements

Robert Gamble, director of strategic practice initiatives for the Community Oncology Alliance, said that about 400 practices began application process when the OCM was announced. However, nearly half of them withdrew from it because of its difficulty. That’s when the COA pulled together a team to educate its remaining members about its functioning. This strategy was critical since practices said that they do not have enough details about how OCM works and is not sure whether it will be a success.

“The Oncology Care Model encourages practices to improve care and lower costs through episodic and performance-based payments that reward high-quality patient care. The Oncology Care Model is one of the first CMS physician-led specialty care models and builds on lessons learned from other innovative programs and private-sector models,” CMS said in a press release.

“Medicare arm of the Oncology Care Model includes more than 3,200 oncologists and will cover approximately 155,000 Medicare beneficiaries nationwide,” the agency added. Around 17 players are participating in this program and CMS plans to cooperate with them to reduce the cost and increase the quality at the same time.