The first 12 months of the Center for Medicare and Medicaid Innovation’s Oncology Care Model (OCM) have been a significant learning experience for participants. Practices have had to come to grips with how different OCM is from other bundled payment models like the Comprehensive Care for Joint Replacement (CJR) or Bundled Payments for Care Improvement (BPCI) programs, which have clear-cut provider attribution and target prices at the time of episode initiation. OCM is a unique animal demanding a sharp understanding of the program’s barriers to success, which I explored in an article featured in Becker’s Spine Review, “A Year into OCM: Five Key Challenges.”
One challenge stressed in that post is that there are two parts to achieving a performance-based payment. The first step is to have a net episode expenditure amount below the overall target amount. Then, the Centers for Medicare and Medicaid Services (CMS) may issue a payment for savings if the practice is reporting to the OCM data registry, has achieved a minimum quality performance threshold, and has implemented all required practice redesign activities.
These practice redesign activities are fairly involved. They require commitment by leadership, strategic implementation, and an investment of resources—but they are also critical to achieving performance-based payment and improving patient care. The good news is that for practices participating in OCM, CMS included a Monthly Enhanced Oncology Services (MEOS) payment to help facilitate practice redesign activities. A practice will receive $160 per beneficiary per month for every month that the beneficiary was enrolled in an OCM episode. The only time those payments would be rejected is if the patient entered hospice or died.
MEOS payments provided an incentive for practices to participate in the program. By giving them the ability to offset some of the costs to implement redesign activities, practices can improve the experience and care delivered to their patients. Here, we examine four strategies that participants are addressing as part of their practice redesign efforts.
- Increasing access through longer hours: Extending oncology clinic hours in the evenings and on weekends and holidays gives patients 24/7 access to avoid emergency department utilization. A practice that implemented this found that patients who visited the extended-hour oncology clinic were treated and released 70% of the time. Otherwise, these patients would have gone straight to the emergency room to receive care. The main reasons found for the visits were management of medications, needing to relieve pain, or addressing other types of symptoms—things that did not require emergency services.
- Normalizing and expanding palliative care: Many practices are trying to embed palliative care within existing services and to incorporate the services into satellite sites. If providers tell a patient that he or she must go home and make a separate appointment to go to another setting for palliative care, overwhelmed patients are not likely to follow those steps. Instead, providers are bringing palliative care to the patient. For example, if a patient is receiving an infusion for several hours, a palliative care specialist could meet with the patient during that time to talk about his or her advanced care plan.
- Use of nurse and lay navigators: Bringing on nurse or lay navigators to help with the care plan can greatly improve communications between clinics, the patient, and their caregivers—and can connect the patient to much-needed resources.
- Identifying what events should trigger palliative consultations: Practices are integrating depression scales and distress screenings into visits to assess a patient’s physical, social, or financial distress. Since cancer is such a life-encompassing event, the results of the screenings can trigger the need to speak with a palliative care specialist or to receive psycho-oncology services. Services provided through this outreach can include discussing the goals of therapy, setting up an advanced care plan, and even things like coordinating transportation or finding a babysitter for a patient’s child. While it may not seem like much, these kinds of activities can really help a patient throughout the episode.
Despite the challenges involved in OCM, participants can create significant benefits for their patients through adjustments to staffing, business hours, and work flow. Even better, practice redesign activities are incentivized through MEOS payments. They are worth the time, effort, and investment, as these essential changes will help participants work toward performance-based payment.