Nearly 200 physician groups and 17 payers are participating in the CMS Oncology Care Model aimed at lowering the cost of cancer care by giving physicians financial and performance accountability for episodes of care involving administration of chemotherapy.1

Participants are Medicare-enrolled physician groups, including hospital-based practices, that furnish chemotherapy treatment. They are required to provide enhanced services including care coordination and patient navigation to ensure that patients receive timely, coordinated services. Commercial insurers participating in the five-year program will align their oncology payment models with the Medicaid model.

Physician practices will receive a monthly care management payment for each patient in the program, as well as performance-based payments. CMS announced that it will measure quality using patient and practice-related measures and claims-based measures. The quality measures were selected across four of the National Quality Strategy Domains, including Communication and Care Coordination; Person and Caregiver-Centered Experience and Outcomes, Clinical Quality of Care, and Patient Safety, CMS said in a written statement.1

In other recent action, in the Outpatient Prospective Payment System Proposed Rule (OPPS) for 2017, CMS proposed eliminating patient satisfaction on pain control measures from value-based purchasing. The agency said it is proposing the change in response to concerns from healthcare providers that the questions about pain management on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) give doctors an incentive to over-prescribe opioid drugs.

REFERENCE

  1. U.S. Department of Health and Human Services. HHS Announces Physician Groups Selected for an Initiative Promoting Better Cancer Care. June 29, 2016: http://bit.ly/29442Cp.