Six years after its launch, CMS’ Oncology Care Model ended on June 30, 2022. Oncology practices that participated and stayed through the entirety of the program had clinical buy-in for the delivery of value-based care for cancer patients. However, despite CMS’ desire for a replacement model to continue OCM’s practice transformation, its Enhancing Oncology Model didn’t attract critical mass. At this point, you may be asking yourself, “What happened to all the practices that participated in OCM? Why didn’t they choose to continue?” In this blog, DataGen will answer those questions with three observations about EOM. Observation #1: Failure to meaningfully incorporate clinical adjustments CMS failed to incorporate clinical adjustments into EOM’s target price methodology in a meaningful way, beyond what was demonstrated in the final performance periods of OCM . Instead of factoring clinical data elements into the underlying cancer-specific regression models, EOM continues to incorporate a ...

Tackling Statewide Planning and Research Cooperative System data is a large lift for New York state Article 28 hospitals and ambulatory surgery centers. This can be even more challenging when the state updates or adds SPARCS requirements and adjusts timeframes. In this blog, we’ll outline three SPARCS submission deadlines you need to know. Plus, we’ll cover how the Department of Health addresses statements of deficiency and what it could mean if your facility receives one. 2023 SPARCS data submission compliance deadlines As New York hospitals and ambulatory surgery centers know well, DOH requires SPARCS data submission for its comprehensive all-payer data reporting system. Facilities must submit 100% of required clinical, billing, admission, discharge and transfer data with 100% accuracy, on a quarterly basis and by a set date. 1. Quarter 1 2023 data Facilities that haven’t submitted their first quarter 2023 SPARCS data began receiving statements of deficiency last month. (See the “Wh...

Are you a primary care practice that’s considering joining the Making Care Primary model? If so, you may have concerns about the experience needed to participate in a value-based care model. In this blog post, we’ll explore whether VBC experience is a requirement to apply for MCP and what benefits you can expect from the program, regardless of your experience level. Is value-based care experience required for MCP? Primary care providers don’t need VBC experience to apply for MCP. However, since MCP is a multi-state initiative , you do need to be located in one of the following states: Colorado; Massachusetts; Minnesota; New Jersey; New Mexico; New York; North Carolina; or Washington. Note, in New York only upstate counties are included under the model. See Appendix D in the Making Care Primary Request for Applications for more information.  Is there an advantage for practices with little to no VBC experience? One of the key benefits of the model is that primary care providers who...