APM for medical oncology? (the OCM)

[FreakFlag]

...APM for medonc?

in the big picture, doesn't the cost of medonc care significantly exceed the cost of radonc care?

is the medonc-allied pharma lobby just so strong that they can prevent a medonc APM?

is radonc APM just a pawn or smokescreen in a bigger scheme?

sorry so many questions, just hungover from NYE still


[EDIT]: my bad, I was not educated about the medonc OCM of 2016-2021. my medoncs never mentioned it so i bet they're not doing it. thanks to everyone who posted replies about OCM. btw, I was sipping Wild Turkey.

• one-sided risk = MIPS APM for medoncs
• two-sided risk = advanced APM for medoncs
• sounds like medoncs APPLY to participate in the OCM and can receive performance bonus payments.
• didn't see anything about bundle payment based on cancer diagnosis like the radonc APM
• https://www.hhs.gov/guidance/sites/...efresher_learning_event_slides_20200305_2.pdf

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[medgator]

Azar is a big pharma swamp creature. Moreover, Varian and ASTRO don't have the winningest lobbyists the way big pharma does

 

[DoctwoB]

why no APM for medonc?

in the big picture, doesn't the cost of medonc care significantly exceed the cost of radonc care?

is the medonc-allied pharma lobby just so strong that they can prevent a medonc APM?

is radonc APM just a pawn or smokescreen in a bigger scheme?

sorry so many questions, just hungover from NYE still

Medicare can’t even leverage their buying power to set drug prices or use the threat of not carrying on formulary. Or buy drugs legally from Canada. Every attempt to do so has been blown up by pharma lobbying. And while I’m generally on team (moderate) D with healthcare policy, there are plenty of guilty democrats here as well.

The sad truth is the physician lobby is small potatoes when talking about pharmacy or industry money. So Medicare goes after the things they can get away with. Namely cutting/capping physician payment.

Edit: was curious so looked up the numbers. AMA spending on lobbying is 20 mil/year. And most of that AMA money is spent arguing for physicians as a whole, they could care less about “revenue neutral” changes to individual specialties. Individual specialty societies are even more laughable. Uropac for urology is about 200k/year.

Pharma is 250 mil/year.

 

[thecarbonionangle]

Curious what’s your drink of choice? You’re always full of questions after a few! Happy new year everyone!!!

 

[thecarbonionangle]

Azar is a big pharma swamp creature. Moreover, Varian and ASTRO don't have the winningest lobbyists the way big pharma does

Please don’t offend swamp creatures. They have feelings.

 

[BobbyHeenan]

I wonder what sort of outside foreign lobby plays in this too.

I have a very rudimentary understanding of drug development and prices, but it's my understanding that the US basically subsidizes drug costs (I guess indirectly) for other countries.

It's time to negotiate drug prices with big pharma on behalf of US citizens.

 

[RickyScott]

I

I wonder what sort of outside foreign lobby plays in this too.

I have a very rudimentary understanding of drug development and prices, but it's my understanding that the US basically subsidizes drug costs (I guess indirectly) for other countries.

It's time to negotiate drug prices with big pharma on behalf of US citizens.

As I understand it, there is a law that specifies Medicare can not negotiate drug prices!
Pharma is biggest industry in certain key states nJ, pa,... and Delaware.

 

[thecarbonionangle]

Oncology Care Model | CMS

The Center for Medicare & Medicaid Innovation (CMS Innovation Center) is developing new payment and delivery models designed to improve the effectiveness and efficiency of specialty care. Among those specialty models was the Oncology Care Model, which aimed to provide higher quality, more highly...

innovation.cms.gov

 

[Irradi8or]

why no APM for medonc?

in the big picture, doesn't the cost of medonc care significantly exceed the cost of radonc care?

is the medonc-allied pharma lobby just so strong that they can prevent a medonc APM?

is radonc APM just a pawn or smokescreen in a bigger scheme?

sorry so many questions, just hungover from NYE still

Unsure if this is a rhetorical question or you haven't been following health policy? The OCM is currently ongoing and has been extended an extra year d/t covid, and there's already a successor APM called the OCF in the pipeline. It's forced practices into two sided risk if they haven't achieved savings in a one sided model (or must leave the OCM), and the OCF may mandate two sided risk after a trial period. However, OCM has fallen short to date with regards to cost savings.

 

[medgator]

I

As I understand it, there is a law that specifies Medicare can not negotiate drug prices!
Pharma is biggest industry in certain key states nJ, pa,... and Delaware.

The VA is allowed to negotiate. Small potatoes though compared to CMS

 

[Chartreuse Wombat]

Unsure if this is a rhetorical question or you haven't been following health policy? The OCM is currently ongoing and has been extended an extra year d/t covid, and there's already a successor APM called the OCF in the pipeline. It's forced practices into two sided risk if they haven't achieved savings in a one sided model (or must leave the OCM), and the OCF may mandate two sided risk after a trial period. However, OCM has fallen short to date with regards to cost savings.

My understanding is that this is a voluntary program for MedOnc. This is completely different than the mandatory element of RO-APM. In voluntary programs the only practices that participate are those that think they can manage the downside risk. In other pilot programs the results of the voluntary phase are rarely reproduced when a large sample is included.

Just rearranging deckchairs on the Titanic.

Long-term fiscal impact of the of COVID-19 pandemic on the overall federal debt and Medicare Part A Trust Fund shortfall cannot be overlooked

Recommendations from healthcare economists for savings to preserve Part A Trust Fund focus more on taxes and less on providers.

www.hfma.org

Less focused on is the impact to the Part A Trust fund which is projected to be insolvent within six years.

 

[randomname2018]

340b

 

[DoctwoB]

My understanding is that this is a voluntary program for MedOnc. This is completely different than the mandatory element of RO-APM. In voluntary programs the only practices that participate are those that think they can manage the downside risk. In other pilot programs the results of the voluntary phase are rarely reproduced when a large sample is included.

Just rearranging deckchairs on the Titanic.

Long-term fiscal impact of the of COVID-19 pandemic on the overall federal debt and Medicare Part A Trust Fund shortfall cannot be overlooked

Recommendations from healthcare economists for savings to preserve Part A Trust Fund focus more on taxes and less on providers.

www.hfma.org

Less focused on is the impact to the Part A Trust fund which is projected to be insolvent within six years.

It’s also interesting to see where some incentives are.

It definitely incentivizes earlier palliative and hospice care with less 10th line chemo and icu care which is good. It likely disencentivizes earlier use of immunotherapy which may or may not be good depending on the disease site and the data. It also may bias you towards not giving neoadjuvant in areas like bladder or upper tract Tcc and instead use adjuvant in the half of patients or so who need it.

 

[Irradi8or]

My understanding is that this is a voluntary program for MedOnc. This is completely different than the mandatory element of RO-APM. In voluntary programs the only practices that participate are those that think they can manage the downside risk. In other pilot programs the results of the voluntary phase are rarely reproduced when a large sample is included.

Just rearranging deckchairs on the Titanic.

Long-term fiscal impact of the of COVID-19 pandemic on the overall federal debt and Medicare Part A Trust Fund shortfall cannot be overlooked

Recommendations from healthcare economists for savings to preserve Part A Trust Fund focus more on taxes and less on providers.

www.hfma.org

Less focused on is the impact to the Part A Trust fund which is projected to be insolvent within six years.

Yes indeed, it is voluntary, but I can say first hand as an OCM practice that between our med onc's low scores in MIPS vs not-so-stellar performance in the two-sided risk OCM advanced APM, it's a bit like choosing lesser of two evils. The RO Model is mandatory for 30%, but based on the final rule, it appears that negative impact on physician groups won't be as large as the impact on HOPD technical owners.

MFN on the other hand is a different story. There are delays and law suits, and I do hope this rule changes substantively. It would be a 7 year mandatory "demonstration project" that will impact many aspects of the drug pipeline, esp. community practices that rely on infusion/drug/IOD revenue.

News & Analysis

News & Analysis

www.asco.org

 

[medgator]

Yes indeed, it is voluntary, but I can say first hand as an OCM practice that between our med onc's low scores in MIPS vs not-so-stellar performance in the two-sided risk OCM advanced APM, it's a bit like choosing lesser of two evils. The RO Model is mandatory for 30%, but based on the final rule, it appears that negative impact on physician groups won't be as large as the impact on HOPD technical owners.

MFN on the other hand is a different story. There are delays and law suits, and I do hope this rule changes substantively. It would be a 7 year mandatory "demonstration project" that will impact many aspects of the drug pipeline, esp. community practices that rely on infusion/drug/IOD revenue.

News & Analysis

News & Analysis

www.asco.org

MFN isn't a sustainable model where practices are buying the drug at a certain cost. The premise behind it is sound though and the US shouldn't be the sole subsidizer for pharma while the rest of the developed and developing world benefits

 

[Irradi8or]

MFN isn't a sustainable model where practices are buying the drug at a certain cost. The premise behind it is sound though and the US shouldn't be the sole subsidizer for pharma while the rest of the developed and developing world benefits

Agree! Drug prices must come down, and more needs to be done at the pharma level more directly. However, one person's waste is another person's income, and it will impact multiple stakeholders, including med onc colleagues.

 

[RickyScott]

Agree! Drug prices must come down, and more needs to be done at the pharma level more directly. However, one person's waste is another person's income, and it will impact multiple stakeholders, including med onc colleagues.

I am not sure it will have huge impact on medonc colleagues who work for hospitals. Their income is based on RVus from e and m visits, with a salary largely determined by supply and demand. (Pathologist have huge technical billing, what has that done for them?)

 

[Irradi8or]

I am not sure it will have huge impact on medonc colleagues who work for hospitals. Their income is based on RVus from e and m consults, salary determined by supply and demand. (Pathologist have huge technical billing, what has that done for them?)

Hospitals themselves will be affected, but hospital employed Med oncs not as much. However for those of us in multi specialty private practices that are not delivering infusion in hospitals it’ll be a big impact.

 

[RickyScott]

I have always been unclear re the magnitude of profitability of medonc in the typical hospital, given 3-5% limitations on drug profits. Payment is often delayed leading to interest costs and a denial or 2 on very expensive drugs will inevitably occur. Also, rarely an expensive drug will be used in the inpt setting. One in a thousand denials, a rare charity or inpt case has a dramatic effect on profit. Even without insurance barriers/hoops, can expect one in a thousand denials based on paper work errors from lazy and incompetent poorly paid clerical worker/biller at typical hospital.

Large practices like fcs can exploit economies of scale as long as all physicians committed to following certain pattern ie giving weekly hematopoietic support and all using the same drug on certain pathways. For typical community hospital medonc this does not apply and most will reject being dictated what drugs to prescribe.

 

[OTN]

MFN will never come to pass, due to litigation and legislation. It would have had a big negative impact on oncology revenue no matter the practice setting.

 

[deleted941485]

Hospitals themselves will be affected, but hospital employed Med oncs not as much. However for those of us in multi specialty private practices that are not delivering infusion in hospitals it’ll be a big impact.

My guess is that at the end of the day it won’t reduce costs more than it’s will just change where they are given (hospital based facility vs private office).

Private Med oncs survive on drug revenue. If they can’t then they close or go hosp employed...that’s it

 

[medgator]

My guess is that at the end of the day it won’t reduce costs more than it’s will just change where they are given (hospital based facility vs private office).

Private Med oncs survive on drug revenue. If they can’t then they close or go hosp employed...that’s it

MFN, like 340b before it will simply accelerate medical oncology moving to hospital employment

 

[deleted941485]

MFN, like 340b before it will simply accelerate medical oncology moving to hospital employment

The fed has done this with several specialties to push physicians to employ. Decrease reimbursement and it insanely expensive to practice on your own.