CMS’ new Enhancing Oncology Model seeks to improve cancer care coordination, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment.
Launched July 1, EOM replaces the Oncology Care Model as CMS seeks to build on lessons learned and challenges of cancer care cost management.
In this blog, we explore five best practices your oncology practice can use to kick-start EOM.
How to operationalize your Enhancing Oncology Model
1. Lay the foundation with core value-based care principles
While CMS models change, many value-based care elements are evergreen and can benefit from practices that:
- identify physician champions;
- inform and align practice leadership;
- define success markers to track progress;
- identify core team member roles and goals; and
- establish quality measure reporting.
The latter may require EOM practices to add metrics to their electronic health records, such as depression screening and pain management. While this example is model-specific, reassessing quality programs and how EHRs can best support them is a core practice redesign principle. See step four below for more details.
2. Refine patient identification
Poorly defined VBC populations lead to missed opportunities for more targeted patient care and maximum performance incentives. This is particularly true for EOM, which CMS has limited to seven cancer types — breast cancer, small intestine/colorectal cancer, lung and prostate cancer and chronic leukemia, lymphoma and multiple myeloma — with select diagnostic codes and initiating chemotherapy treatments. Practices are required to abstract and submit clinical data elements not found in claims data for at least 90% of their total attributed episodes on a semi-annual basis.
CMS will use this information to apply clinical adjustments to control for known differences in episode expenditures. Ever-metastatic status will be an applicable adjustment for breast cancer, small intestine/colorectal cancer and lung cancer episodes. Human epidermal growth factor receptor 2 status will be an additional adjustment for breast cancer episodes.
Clinical specificity paints a living picture of a practice's oncology patients: who they are, what they need and how their experience and outcomes can be improved. This specificity is vital for oncology care episodes, which can include a broader range of services than more straightforward VBC models.
3. Earn and reinvest incentives
EOM practices may submit monthly enhanced oncology services claims for attributed patients in each month of the episode (up to six times total). Practices will receive $70 per EOM beneficiary per month and an additional $30 per EOM beneficiary per month for beneficiaries who are dually eligible for both Medicare and Medicaid.
The additional payment for dual eligible beneficiaries will not be included in the EOM practice’s total cost of care accountability. This is meant to avoid any potential disincentive for treating beneficiaries who tend to account for higher episode expenditures.
Month Enhanced Oncology Services payments are intended to support the implementation of enhanced oncology services. Providers can use these payments to fund ongoing redesign activities that foster practice-wide quality improvement beyond EOM model requirements.
4. Embrace practice redesign
Like VBC in general, practice redesign is a discipline. It takes time and requires continuous investment to pay dividends, financial and otherwise. Required EOM redesign elements include:
- 24/7 access to clinicians who can access the patient’s EHR in real-time;
- outpatient navigation services that span the cancer care journey;
- detailed care plans shared with patients;
- patient experience data; and
- social drivers of health screening as part of routine practice.
The last requirement is new to EOM (versus OCM) and aligns with CMS' focus on health equity and how social determinants of health impact health outcomes.
Need key data insights backed by an analytics-first approach? Contact DataGen for a free consultation.
If you want more details on how EOM differs from CMS' prior demonstration (OCM), read DataGen’s September blog. To see DataGen's key findings and in-depth analysis of EOM’s national baseline and prediction module methodology, watch our recorded webinar.
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