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Our Take: CMS introduces new oncology care model, proposes changes to Medicare Shared Savings Program

Jul 11, 2022

Last week CMS introduced the Enhancing Oncology Model (EOM), designed by the Center for Medicare and Medicaid Innovation as a successor to the Oncology Care Model, which ended in June.

Like the previous oncology model, EOM will focus on value-based, patient-centered care. Payment incentives will encourage participants to improve their quality of care by implementing “participant redesign activities.” Some of the activities are the same as in the Oncology Care Model (e.g., patient navigation and care planning), while others will be new “enhanced services,” such as collecting electronic patient-reported outcomes.

Health equity is one of CMS’ priorities, and that priority is reflected in the design of EOM. Participants will be required to report patient demographic data, screen patients for health-related social needs that can affect treatment, such as nutritional issues and transportation challenges, and develop plans to address health equity gaps in their patient population.

The new model has a two-part payment structure. Participants will be responsible for the total cost of care during six-month treatment episodes.

Depending on their expenditures and quality performance, they can either earn a performance-based payment or owe a performance-based recoupment. They will also have the option to bill a “monthly enhanced oncology services” (MEOS) payment for providing the enhanced services to beneficiaries during each six-month episode. The model also includes an extra MEOS payment for beneficiaries who are eligible for both Medicare and Medicaid.

Participation in EOM will be voluntary, and applications are being accepted through the end of September. Oncology practices that treat Medicare beneficiaries with systemic chemotherapy for any of the following types of cancer will be eligible to participate: breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.

EOM will begin next July and run for five years, leaving a one-year gap between the end of the Oncology Care Model and the start of the new model.

Additional details about the model and the application to participate are available on a new EOM website.

Separately, in a fact sheet published Thursday, CMS announced several substantial changes it wants to make to the Medicare Shared Savings Program (MSSP) as part of the proposed rule for the 2023 Medicare Physician Fee Schedule.

One of the proposed changes is intended to address feedback CMS received from providers that treat rural and underserved populations. Providers have said they need upfront capital to implement the infrastructure required to participate in the program, and they need more time participating in a one-sided model before transitioning to a two-sided model with downside risk.

In response, CMS is proposing the provision of advanced shared savings payments to low-revenue ACOs that are new to MSSP and “other modifications” to existing policies that would provide more flexibility in the transition to performance-based risk.

Other changes — such as adjustments in the program’s benchmarking methodology — are designed to sustain participation by existing ACOs and increase the overall number of ACOs participating in MSSP. CMS is also proposing changes that would reduce participants’ administrative burden.

The agency projects the changes could result in additional shared savings payments to ACOs totaling $650 million.

Comments on the proposed changes are being accepted through Sept. 6.

Our Take: In general, industry groups such as the American Society of Clinical Oncology and the Community Oncology Alliance (COA) responded positively to the announcement of the Enhanced Oncology Model but criticized certain aspects — like the one-year gap between the old model and the new.

We get it. Oncology practices made significant investments so they could participate in the Oncology Care Model, and now they have to go a whole year before they’ll receive EOM payments.

But we also realize that CMS has been working to streamline the number of alternative payment models (APMs) it offers, in response to MedPAC reports and industry feedback. The Oncology Care Model has been one of the more successful APMs, and it seems that CMS has been careful to preserve what was good about that model while adding components to the new model that might improve health equity.

Given the lead time required to complete the application process for participation, evidently CMS was’t able to roll out the new model in time to avoid the gap.

Other criticisms include the restrictions on the types of cancer included in the new model (the previous model included all types), and the lower MEOS payments in the new model ($70 vs. $160 in the Oncology Care Model).

In a statement, Ted Okon, executive director of the Community Oncology Alliance, commented on the reduced payments:

“COA is extremely supportive of screening for health-related social needs and electronic patient-reported outcomes (ePROs), [but] it seems unfair to burden practices with more work but pay less for it, particularly as practices are dealing with the return of the Medicare sequester cut, inflation, and ongoing COVID-19 practice challenges.”

By comparison, Cliffords Gaus, CEO of the National Association of ACOs (NAACOS), had only good things to say about the proposed MSSP changes — though he did note in his statement that the organization is “still studying the major changes.”

MSSP has been another successful APM, and CMS seems to have listened to input from various stakeholders in its efforts to make the model even better.

What else you need to know
Novartis will be cutting 8,000 jobs from its workforce, globally. The reductions are part an organization-wide restructuring initiative announced in April, which includes merging the company’s oncology and pharmaceuticals business units into one called Innovative Medicines. As a result of the restructuring, Novartis hopes to save at least $1 billion by 2024. “The new structure will be both leaner and simpler and as such the company intends to eliminate roles across the organization,” Novartis said in a statement. Currently, the company has approximately 108,000 employees worldwide. An estimated 1,400 of the job cuts will be in Switzerland, where Novartis is based.

St. Louis-based SSM Health has acquired SLUCare Physician Group, the academic medical practice of Saint Louis University, building on a relationship between the two organizations that goes back to 1903. Although financial terms were not disclosed, SSM Health said in the announcement that the agreement “represents a significant investment in the Saint Louis University School of Medicine to expand clinical research, medical training, and education across the region.” The more than 600 faculty members, other academic professionals and staff of SLUCare will be a dedicated academic physician division within the SSM Health – St. Louis network. Together with SSM Health Medical Group’s 600-plus community-based providers, they will deliver care at more than 50 physician offices and virtually, the health system said.

Exeter Health will join Cambridge, Mass.-based Beth Israel Lahey Health. The organizations signed a definitive agreement on June 30, which was authorized by their respective boards and builds on the letter of intent they signed earlier this year. The Exeter, N.H.-based system includes Exeter Hospital, Core Physicians, and Rockingham Visiting Nurse Association & Hospice. Collectively, it employs more than 2,400 staff members. The proposed deal is subject to regulatory approval.

Northshore – Edward-Elmhurst Health has formed the Edward-Elmhurst Medical Group (EEMG), which the health system says is one of the largest health care provider groups in the Chicago area. According to the announcement, EEMG has more than 650 clinicians, “including hospital-based and ambulatory providers, and those from Linden Oaks Medical Group.” The total also includes 123 providers associated with Elmhurst Clinic, which became part of EEMG on July 1. The medical group serves patients in 26 communities at 50 locations in a six-county area.

Memorial Hermann Health System is partnering with Contessa Health to give its patients the option of receiving acute hospital care at home. Eligible patients will be discharged directly from the emergency department and transferred home along with remote monitoring devices. A care team will provide in-person and virtual visits on a daily basis. Through the new partnership, patients of the Houston, Texas-based health system will also have the choice of receiving home-based skilled nursing care, rehabilitation care, and palliative care. Contessa Health, owned by Amedisys, partners with health systems and health plans to deliver high-acuity care in the home through a risk-based model it calls Home Recovery Care.

Teladoc Health has added new services to Primary360, its primary care offering. The additional services — which include in-network referrals and care coordination support, free, same-day delivery of prescription medications, and in-home phlebotomy — are intended to improve patients’ access to care, adherence to treatment plans, and outcomes. Teladoc said in a press release that it is partnering with Capsule for the prescription delivery service and with Scarlet Health for the on-demand phlebotomy service.

Sentara Healthcare will have a new president and CEO in September, when Howard Kern retires after four decades with the organization. Sentara’s board of directors selected Dennis Matheis as Kern’s successor. Matheis has been president of Sentara Health Plans and an executive vice president at Sentara Healthcare since 2018. In separate news, Memorial Sloan Kettering Cancer Center announced that it, too, will have a new president and CEO in September. Dr. Selwyn Vickers will take the reins from Dr. Craig Thompson, who has been president and CEO since 2010. Currently, Dr. Vickers is the senior vice president for medicine and dean of the Heersink School of Medicine at the University of Alabama at Birmingham (UAB), and CEO of both the UAB Health System and the UAB/Ascension St. Vincent’s Alliance.

What we’re reading
We Have A National Strategy For Accountable Care, So What’s Next? Health Affairs, 6.30.22
What’s Wrong With Health Insurance? Deductibles Are Ridiculous, for Starters. New York Times, 7.7.22
Institutionalizing Misinformation — The Dietary Supplement Listing Act of 2022. NEJM, 7.7.22

What else we’re reading
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