Delay in Performance Period Results Challenges Practices Participating in OCM

Practices participating in the Oncology Care Model (OCM) recently received the results from performance period 2, but they’re currently enrolling patients for performance period 5. This lag time between the end of a performance period and the release of the full report represents a challenge for practices looking to improve.

Marcus Neubauer, MD, chief medical officer of the US Oncology Network, noted that while he recognizes that the lag time is unavoidable, it does hamper the practices participating in OCM and makes it difficult to enact changes based on the results they get.

“In an ideal setting, you get real-time data, and you are continuously learning,” he said, but the reality is that there will always be a lag with claims data.

Charles Saunders, chief executive officer of Integra Connect, explained that it takes about 6 months before all of the claims are collected, and then there is another 3 months for CMS to analyze the data. This timeline means it can be almost a full year after a performance period before practices receive the report card for that period.

This lag time can be difficult when it comes to the Monthly Enhanced Oncology Services (MEOS) payments, he explained. For instance, the performance period report includes patients who are attributed to a practice but for whom there are no associated MEOS payments.

“That means you were attributed patients that you’ve never billed a MEOS payment for,” Saunders said. Practices have up to a year to bill, “but if the data that you’re getting is pretty close to a year, there’s just not much time to go in to recover those charges that you may have overlooked and not billed for.”

Another challenge with the lag time between when a period ends and when practices receive the report is that practices can have trouble pinpointing what they did almost a full year ago that caused the results they are now seeing.

While working with practices, Integra Connect has noticed the big question is: Why is this happening? Saunders said that practices that improve can sometimes be unsure of what is driving the improvement, while those that didn’t generate savings may have trouble understanding why.

“It’s just a fact that those results are delayed, but when you do get them it really is an opportunity to look at the data, learn where you’re doing particularly well on quality metrics, or not, and learn where you’re doing particularly well, or not, on some of the financial cost metrics,” Neubauer said.