How Has the OCM Evolved? Year 1 Provider Updates

The 192 participating practices in CMS’ Oncology Care Model (OCM) have received performance feedback from the Center for Medicare & Medicaid Innovation. What have been the major challenges faced by these practices? Were there surprises or were the 1-year results as anticipated? Participants from 2 oncology community practices—an oncologist—administrator combination—shared their experience with the attendees at the Community Oncology Alliance’s Payer Exchange Summit on Oncology Payment Reform, held October 23-24, in Tysons Corner, Virginia.

The session, moderated by Basit Chaudhry, MD, PhD, Tuple Health, saw participation by Jeff Patton, MD, and Aaron Lyss, MBA, both from Tennessee Oncology, and Lucio Gordan, MD, and Sarah Cevallos, both representing Florida Cancer Specialists & Research Institute; representing 2 of the bigger practices participating in the OCM.

The discussion started with a conversation around the biggest challenges faced by oncology practices, which Cevallos identified as “physician communication and culture change within the practice—having providers understand the new requirements.” Explaining that Medicare enrollees constitute 50% of the practice's patients, she noted that her practice needed a big change to ensure all reporting and care delivery requirements were in place within a 90-day timeframe.

Patton struck a common chord when he acknowledged that culture change is difficult even when every patient is handled in the same way with respect to care delivery, and it “becomes schizophrenic” when each patient is on a different reimbursement path. This complicated physician on-boarding even more, Cevallos said, as it became challenging to make them understand the different tracks: OCM, fee-for-service (FFS), the Merit-based Incentive Program, etc. Gordan added that culture change encompassed the need to recruit additional staff, longer working hours, weekend hours, and keeping patients out of the emergency department (ED), among others, all of which were challenges. Additionally, being a big practice with more than 200 physicians, non-converging opinions were a problem as well.

Adequate data management is just as vital, according to Lyss. “Just tracking the patient through the process is fundamental to participating in this model…and we have made much progress compared with a year ago,” he added, pointing to the influence of improved infrastructure and quality reporting changes on his practices’ capacity to participate in commercial payer models. “Risk adjustment is CMS’ way of keeping score, so understanding risk adjustment has helped us feed into our performance on commercial payer programs,” Lyss said.

Cost control pillars. The panelists identified 4 common pillars of ensuring care costs remain within limits:

• Clinical pathways to reduce variability and avoid toxicity
• Upfront triage for symptom management and to reduce ED admissions
• Infusing palliative care services throughout patient care
• Care coordination

At Florida Cancer Specialists & Research Institute, private practice physicians have access to data off patients they have referred to the oncology clinic, which, Gordan explained, has helped ensure patients stay out of the ED.

An ideal strategy for physician engagement is seeking insight on the front-end, said Lyss, and it also helps improve program implementation.

Cevallos believes there is an imminent need to streamline the quality reporting requirements. “We will have to draw a line soon because it’s just getting too much, managing FFS versus value-based care, she said. Another important point that Cevallos noted was paying adequate attention to keeping healthcare local. Patton emphasized that it is important to meet practices at their level and to understand the different challenges faced by a single-doctor practice versus a bigger practice with multiple physicians on staff.

“We’d like more interaction with payers,” Gordan said, “So we can identify metrics that payers consider important,” and to normalize outputs from value-based and other contracts without reinventing the wheel.

“We need payer—provider conversations on ways to keep the total cost of care down,” said Patton.