Health Information Management

CMS begins oncology bundles

Accreditation Insider, July 5, 2016

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On July 1, nearly 200 group practices began a five-year demonstration program of CMS’s Oncology Care Model. The model’s goal is to improve the quality and decrease the costs of cancer care nationwide. Cancer is the second leading cause of death in America, with 22.5% of all deaths in 2014 resulting from some form of it. Meanwhile, the costs of cancer care are expected to rise to $158 billion in 2020, an increase of 27% over 2010.

"The Oncology Care Model encourages greater collaboration and information sharing so that cancer patients get the care they need," said U.S. Department of Health and Human Services Secretary Sylvia M. Burwell, in an announcement. "This patient-centered care model furthers the goal of the Vice President's Cancer Moonshot to improve coordination, care, and outcomes while spending dollars more wisely."

Participating physicians will receive performance-based payments for caring for Medicare cancer patients under a bundled payment model. They’ll also receive a monthly care management payment for each beneficiary. Participating in the Oncology Care Model is 17 health insurance companies, more than 3,200 oncologists, and approximately 155,000 Medicare beneficiaries. The group practices involved will all follow nationally recognized clinical guidelines for chemotherapy, with improved services including:

•    Help coordinating appointments and diagnostic tests outside the practice
•    Availability of test results prior to appointments
•    Access to additional support services
•    24/7 access to the practice itself

“CMS is thrilled with how many physician groups chose to be a part of the Oncology Care Model,” said Patrick Conway, MD, CMS principal deputy administrator and chief medical officer. “We have nearly doubled the number of participants that we anticipated. It’s clear that oncology physicians recognize the importance of this new performance-based, episode-based payment approach to cancer care. As a practicing physician and son of a Medicare beneficiary who died from cancer, I know the importance of well-coordinated care focused on the patient’s needs.”

The project will be completed on June 30, 2021.

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