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CMS Oncology Bundles Set to Begin

News  |  By HealthLeaders Media News  
   June 30, 2016

Participating practices have committed to providing evidence-based, person-centered care for patients receiving chemotherapy. Under the Oncology Care model, performance-based payments go into effect July 1.

Nearly 200 group practices across the country—more than double the amount initially expected by the Centers or Medicare & Medicaid Services—will participate in a five-year demonstration program aimed at improving the quality and cost-effectiveness of oncology care.

The Oncology Care Model, which will involve 17 health insurance companies, more than 3,200 oncologists, and approximately 155,000 Medicare beneficiaries, is scheduled to run from July 1, 2016, through June 30, 2021.

Related: Ready or Not, Here Come Bundled Payments

"The Oncology Care Model encourages greater collaboration and information sharing so that cancer patients get the care they need," said U.S. Department of Health and Human Services Secretary Sylvia M. Burwell, in an announcement.

"This patient-centered care model furthers the goal of the Vice President's Cancer Moonshot to improve coordination, care, and outcomes while spending dollars more wisely."

Under the bundled payment model, participating physician practices will receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, plus a monthly care management payment for each beneficiary.

The two-sided risk model will qualify as an Advanced Alternative Payment Model under the proposed rule for MACRA.

Related: The Secret Sauce for Orthopedics Bundled Payments Success

Physician group practices participating in the program have agreed to provide treatment following nationally recognized clinical guidelines for beneficiaries undergoing chemotherapy, with an emphasis on person-centered care.

Examples of enhanced services provided by the medical groups include:

  • Help coordinating appointments and diagnostic tests outside the practice
  • Availability of test results prior to appointments
  • Access to additional support services
  • 24/7 access to the practice itself

"With this after-hours care, there's a way to treat [symptoms such as] nausea or vomiting… or dehydration without the patient going to the ED and being hospitalized," Patrick Conway, MD, CMS Chief Medical Officer, explained when the model was announced in February 2015.

 "That's where the largest savings from this program will come from."

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