Value-Based Care Veterans: EOM Results & Next Steps
Summary of the Article: Medicare’s EOM Program and Oncology Practices
This article discusses the challenges oncology practices are facing with Medicare’s new Enhancing Oncology model (EOM), which replaced the Oncology Care Model (OCM). Here’s a breakdown of the key points:
* shift from OCM to EOM: The OCM was considered successful but costly ($315 million to Medicare). The EOM was designed to be less expensive and more risk-based from the start.
* Concerns from Practices: Many practices invested heavily in value-based care anticipating a potential mandatory Medicare model. Though, the EOM’s structure is proving arduous, particularly for smaller practices.
* Performance Discrepancies: Practices experienced positive results and bonuses in Performance Period 1 (PP1), but saw substantially reduced or no bonuses in Performance Period 2 (PP2) despite no operational changes. This is causing confusion and concern.
* evaluation Methodology: The EOM evaluates practices based on their performance within specific cancer types, making them vulnerable to the cost of single, expensive cases. It also covers only 7 common cancers, unlike the broader OCM.
* Potential Contributing Factors: Possible reasons for the performance drop include:
* Drug Pricing Changes: Shifts in therapies for pancreatic cancer and the adoption of new 4-drug regimens for multiple myeloma (following the PERSEUS trial and subsequent FDA approval) may have impacted costs.
* Lack of Explanation: Even CMS representatives haven’t been able to fully explain the discrepancy between PP1 and PP2 results.
* Overall Sentiment: Practices are scrambling to understand the data and determine their next steps, with some questioning the viability of continuing with the EOM.
In essence, the article highlights the unexpected difficulties and uncertainties surrounding the EOM, and the frustration felt by oncology practices who invested in value-based care based on expectations set by the previous OCM model.