CMS cancer initiative in flux, causing worry for providers and patients

Cancer patients enrolled in Medicare may soon face difficulties in receiving care unless CMS clarifies future of program.
medical terminology

The clock is ticking for practices and Medicare beneficiaries participating in the Oncology Care Model (OCM) – an important initiative supporting and coordinating care for cancer patients on Medicare. The program stopped enrolling new patients on January 1, 2022 and is scheduled to be terminated on June 30, 2022. However, a new model has yet to be announced.

Discontinuing the model without a replacement could reduce access to care for cancer patients, as well as force practices to lay off staff who coordinate care for patients under the model.

On November 15, 2021 the Community Oncology Alliance – an advocacy organization for community oncology practices and their patients – sent a letter to Administrator Brooks-LaSure and Deputy Administrator Fowler of the Centers for Medicare & Medicaid (CMS) asking that the CMS Innovation Center (CMMI) extend the model through December 31, 2022. CMMI has not responded at this time.

The Oncology Care Model incentivizes participating practices to enable care coordination for Medicare beneficiaries who undergo chemotherapy treatment for a cancer diagnosis. This multi-payer, episode-based payment model incorporates a two-part payment system: A per-beneficiary payment for the duration of the episode, and performance-based payment for participating practices.

CMMI’s silence on the termination of the Oncology Care Model seems counter to the intent of the Strategic Refresh that CMMI released in October, as well as with subsequent listening sessions with stakeholders held in November and December 2021. During those sessions, Innovation Center leaders expressed their commitment to expanding access to value-based payment models for providers and to advancing health equity for beneficiaries.

It is hopeful that CMMI will keep their commitment – either by extending the Oncology Care Model or enabling a smooth transition to a new model while maintaining continuity of care for patients and their providers.

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