CMS Oncology Care Model Starts July 1, Includes QOPI® Measures and Nearly 200 Practices

July 1, 2016

The U.S. Department of Health and Human Services (HHS) announced that nearly 200 physician group practices and 17 health insurance companies were selected to participate in the Oncology Care Model (OCM), a cancer care payment and service delivery model developed by the Center for Medicare & Medicaid Innovation (CMMI). The HHS announcement--made on the same day as Vice President Biden's Cancer Moonshot Summit--was one of several activities that the Cancer Moonshot Task Force and individual Federal agencies announced simultaneously to support the goals of the Moonshot initiative.

OCM begins on July 1, 2016 and runs through June 30, 2021. The model includes more than 3,200 oncologists who constitute a geographically, clinically, and organizationally diverse group of practices providing roughly $6 billion in care for an estimated 155,000 Medicare beneficiaries per year. Participants have committed to providing enhanced services to Medicare beneficiaries such as care coordination and navigation, and they also agree to use national treatment guidelines for care. CMS will in turn supply practice feedback data for continuous care improvement.

Following an in-person meeting and other communication between ASCO and CMMI, the HHS announcement confirms that three of OCM's 12 quality measures are ASCO-submitted measures from the Quality Oncology Practice Initiative (QOPI®). The three measures are:

Measures Name

OCM #

Measure Source

Communication and Care Coordination

Proportion of patients who died who were admitted to hospice for 3 days of more (adapted from NQF[1] 0215 and 0216)

OCM-3

Claims

Person- and Caregiver-Centered Experience and Outcomes

Pain assessment and management (adapted from NQF 0383 and 0384, PQRS[2] 143 and 144)

OCM-4

Registry (practice-reported)

Clinical Quality of Care

Trastuzumab received by patients with AJCC stage I (T1c) to III HER2/neu positive breast cancer (adapted from NQF 1858)

OCM-10

Registry (practice-reported)

ASCO commends CMS for seeking new approaches to physician payment, but concerns remain regarding OCM's limited scope. In comments submitted to CMS on a draft version of the agency's model, ASCO supported testing OCM as well as other payment reform models to determine new approaches to payment for oncology care.

ASCO urges CMMI to test models that moves away from the fee-for-service system, including ASCO's Patient Centered Oncology Payment (PCOP) model, an oncology-specific payment system that will decrease costs, while providing the resources oncology practices need to provide high-quality, high-value cancer care, by matching payment more closely with actual care provided. ASCO has shared PCOP with CMS and private insurance companies, and is currently piloting the proposal.

Stay tuned to ASCO in Action for the latest updates on the OCM, the cancer moonshot initiative, QOPI, and Medicare reimbursement.


[1] National Quality Forum

[2] Physician Quality Reporting System

ASCO in Action