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Move over CJR…Here comes OCM!!!

CMS implemented the Comprehensive Care for Joint Replacement (CJR) bundled reimbursement as of April 1st, 2016, and there are still more innovations coming! The CMS innovation Center announced on July 29th that nearly 200 physician groups and 17 insurance companies will be participating the five year oncology coordinated care initiative, known as the Oncology Care Model. This patient centered care model is designed to improve quality of care, increase the coordination of care for cancer patients at the same or lower cost to the Medicare Fund.

Under the new model, CMS will incentivize participating providers by providing additional reimbursement for:

Episode-based measures (to support enhanced care coordination efforts)

Participating oncologists will receive a monthly $160 care-management payment (Monthly Enhanced Oncology Services (MEOS) payment) for each Medicare fee-for-service beneficiary for which they provide the enhanced coordination and management during episodes of care up to six months. A sample of the coordination of care includes ensuring patients are provided with:

  1. A care plan that contains the 13 components in the Institute of Medicine Care Management Plan outlined in the Institute of Medicine report, “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis”

  2. Providing 24 hours a day, 7 days a week patient access to an appropriate clinician who has real-time access to practice’s medical records

  3. Treating patients with therapies consistent with nationally recognized clinical guidelines


Performance-based measures (to reward higher quality care at lower costs)

Participating oncologists who effectively manage their oncology patients with high quality care and successfully lower cost below a risk-adjusted, practice-specific target amount, will be eligible for additional reimbursement.

While this is certainly an innovative model with both providers and private health plans participating, it will be interesting to see how the complex and confusing reimbursement improves care for cancer patients.

Click here to read more about the Oncology Care Model and reimbursement methodology!

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