Article
The Enhancing Oncology Model, announced in July 2022 during the final days of its predecessor, the Oncology Care Model (OCM), has a similar framework as the early alternative payment model for oncology in Medicare, but there are key differences in reimbursement and especially in practices’ requirements to take on risk.
A majority of practices do not plan to participate in the Enhancing Oncology Model (EOM) when it launches next month, according to survey results released today by the Community Oncology Alliance (COA).
Overall, 71% of the 137 practices that answered the survey do not plan to participate, with the EOM requirement that practices immediately take on 2-sided risk cited as the top reason.
The EOM, announced in July 2022 during the final days of its predecessor, the Oncology Care Model (OCM), has a similar framework as the early alternative payment model for oncology in Medicare, but there are key differences in reimbursement and especially in practices’ requirements to take on risk.
Even practices that have said they plan to pursue EOM after success in the OCM have said they believe a small practice lacking experience with payment models would find the EOM daunting.
They survey found that other major factors in driving the practices’ decisions on the EOM were the “unpredictability of the EOM and drug prices,” and inadequate monthly payments from Medicare to cover required services such as navigation and 24/7 access to health records—which were part of the OCM—along with new services.
Survey results and the reasons why practices fear moving forward are consistent with feedback given at professional meetings and in interviews with The American Journal of Managed Care®. This weekend, an informal poll taken during a session at the American Society of Clinical Oncology (ASCO) showed that most attendees remained unsure about the EOM less than 4 weeks from the July 1 start date.
Hesitation From the Start
After the EOM was announced in June 2022, COA has warned the Center for Medicare and Medicaid Innovation (CMMI) about several features that might deter practices from signing up, even if they had seen success in the OCM. The group noted it collected data from its members after the announcement.
By April, COA Executive Director Ted Okon, MBA, told a meeting of the Quality Cancer Care Alliance that he had warned CMMI officials that without changes, most practices would not sign up.
CMMI agreed to make some adjustments, which were published May 1. And COA surveyed its members from May 1 to May 19 about its plans for EOM participation and concerns with the program. However, 2 key elements did not change:
What the Survey Found
Among the 137 practices that took part in the survey, 61% (83 practices) had participated in the OCM, and 20% (28 practices) had previously participate in 2-side risk models. Survey results showed:
COA leaders emphasized that the survey results do not mean community practices lack commitment to value-based payment models.
“Value-based care is the future of health care, and community oncology practices are eager to bring the latest and greatest care to their patients,” Judith Alberto, MHA, RPh, BCOP, COA director of clinical initiatives, said in a statement. “However, practices cannot do this when the barrier to entry and cost of participation potentially endangers the quality of care they provide, as well as the future stability of the practice.”
“The COA survey should serve as a red alert to CMS and CMMI that the success of the EOM is at risk,” Shiela Plasencia, COA director of practice support, said in the statement. “While it is good that some practices are predicting success in the EOM, that is far from certain. Unfortunately, the downside risk to practices, should this model go wrong, is far too great. CMMI must address the concerns of the majority of practices to ensure widespread success.”
Support for the EOM survey was provided by Janssen Oncology.