Since July of 2016, 190 practices have been engaged in the Oncology Care Model (OCM), a Medicare pilot that seeks to change the way cancer care is provided and reimbursed in the United States. OCM is an example of a bundled payment program, a condition-specific model in which providers accept financial risk for the totality of a patient’s care over a predefined period of time.
OCM is not the first of this kind. Commercial payers have piloted bundled payment models for years, while the Affordable Care Act (ACA) established the Center for Medicare and Medicaid Innovation (CMMI) with the purpose of testing “innovative payment and service delivery models.” One of these models includes Bundled Payments for Care Improvement (BPCI), a voluntary program in which providers may select between 1 and 48 clinical “episodes,” which may range from surgical procedures like major joint replacement of the lower extremity (MJR) and cardiac valve replacement, to medical conditions like congestive heart failure and stroke. With the introduction of the Comprehensive Care for Joint Replacement program in 2016, MJR is by far the most prevalent condition around which bundled payment programs are designed. This prevalence is partially due to the fact that many MJR procedures are elective; on average the variance in MJR patients’ care costs and utilization is relatively low, both of which contribute to the ability to implement standardized care pathways.
Cancer is different.
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