A finalized Medicare payment model for chemotherapy is not much of an improvement from its draft version, according to the American Society of Clinical Oncology.
The Oncology Care Model developed in the Center for Medicare and Medicaid Innovation is designed to be an episode-based, performance-based payment model for chemotherapy that incentivizes high-quality, coordinated care.
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Physicians looking to participate in the program need to meet a number of criteria, according to a frequently asked questions document posted to the CMS website. The criteria include attesting to offering patient access 24 hours a day, 7 days a week to an appropriate clinician who has real-time access to the practice’s medical records; use of a certified electronic health record; utilization of data for continuous quality improvement; providing the core function of patient navigation; documenting a care plan that contains the 13 components in the Institute of Medicine Care Management Plan; and treating patients in accordance with nationally recognized clinical guidelines.
Payments will be based on an episode of care that begins either with an initial chemotherapy administration claim or an initial Part D chemotherapy claim and will include all Medicare Part A and B services received during the 6-month episode.
That design, however, comes up short in a number of areas, according to ASCO.
“We are disappointed they have chosen to pursue only one model – and one that continues to rely on a broken fee-for-service system,” ASCO Chief Medical Officer Richard Schilsky said in a statement.
When CMMI proposed the system in August 2014, ASCO was in support of at least testing the model but expressed concern in comments to the agency at that time that there were not other models being tested.
“We strongly urge {CMS] to also test models that include more fundamental reform, away from fee for service, which represents a change many oncology practices believe is vital to sustaining a robust cancer care delivery system,” ACSO said in its comment letter.
Physicians looking to participate in the Oncology Care Model need to submit a letter of intent to participate by April 23. Applications to participate are due June 18.