What is the Enhancing Oncology Model (EOM)?
The Oncology Care Mannequin (OCM) is useless. The Oncology Care Mannequin was a voluntary, various cost mannequin (APM), that “included monetary and efficiency accountability for episodes of care surrounding chemotherapy administration to most cancers sufferers.” OCM expired on the finish of June 2022, and can be changed by the Enhancing Oncology Mannequin. EOM is a additionally a voluntary mannequin that can run for five years: July 2023 by means of June 2028. [Note: Yes, there is a 1 year gap between the end of OCM and the start of EOM]
Like OCM, EOM permits each oncology doctor group practices (PGPs) in addition to different payers (e.g., business payers, state Medicaid companies) to take part in EOM–the latter by means of multi-payer agreements. Like OCM, below EOM physicians are paid an extra month-to-month charge to offer coordinated care to their most cancers sufferers. Like OCM, EOM will measure worth for most cancers sufferers primarily based on six-month episodes of care the place the initiation of chemotherapy (or related focused therapies) would be the initiating level of the episode. Like OCM, EOM physicians are eligible for retrospective performance-based cost (PBP) primarily based on high quality of care and price financial savings throughout these six month episodes of care (see EOM Truth Sheet, CMS slides). The best way value financial savings bonuses and penalties are calculated are proven within the figures beneath.
There are seven varieties of cancers which can be included in EOM. These embody the next tumor varieties:
- Breast most cancers,
- Persistent leukemia,
- Small gut/colorectal most cancers,
- Lung most cancers,
- Lymphoma,
- A number of myeloma,
- Prostate most cancers
Sufferers are attributed to PGP primarily based on primarily based on the share of analysis and administration (E&M) companies offered between initiating chemotherapy and the 6-month episodes. The PGP should present at the very least 25% of all cancer-related E&M companies throughout the episode to be attributed the episode.
In contrast to the OCM program, nevertheless, the EOM month-to-month funds are much less beneficiant. Medscape reviews that “the CMS Innovation Heart plans to chop the Month-to-month Enhanced Oncology Providers funds within the EOM by greater than half ($70 vs $160 for the OCM), however on the similar time, expects extra work from practices.” Observe that the dually eligible people get an extra MEOS cost of $30 (i.e., $100 complete) per 30 days. The extra work contains extra knowledge assortment resembling “assortment of digital patient-reported outcomes (ePROs), and screening for social wants which will have an effect on remedy, resembling transportation points and dietary wants.” Whereas accumulating these knowledge are actually an excellent factor, it’s not clear if EOM will present adequate funding for well being programs to gather these knowledge. Additional, doctor group practices should provide “24/7 entry to a clinician, affected person navigation companies.”
On the constructive aspect, HHS has acknowledged that it’s going to “encourage different payers (e.g., business payers, state Medicaid companies) to align with its core ideas to advertise a constant method throughout payers and EOM contributors’ affected person inhabitants.” This might scale back the burden on physicians, hospitals and well being programs to must take care of totally different applications throughout totally different payer varieties.
High quality of care can be measured primarily based on the next domains:
- Affected person expertise
- Avoidable acute care utilization
- Administration of signs toxicity
- Administration of psychosocial well being
- Administration of end-of-life care
