Oncology Care Model, part deux

[Gfunk6]

Enhancing Oncology Model | CMS

Currently, there are 41 practices and 3 commercial payers participating in the Enhancing Oncology Model.To view an interactive map of this Model, visit the Where Innovation is Happening page. The 3 participating payers are:

innovation.cms.gov

Just announced by CMS. It is everything the RO APM is NOT, namely:

1. It is voluntary
2. You get paid extra money on top of fee for service

---

Members don't see this ad.

 

[medgator]

Enhancing Oncology Model | CMS

Currently, there are 41 practices and 3 commercial payers participating in the Enhancing Oncology Model.To view an interactive map of this Model, visit the Where Innovation is Happening page. The 3 participating payers are:

innovation.cms.gov

Just announced by CMS. It is everything the RO APM is NOT, namely:

1. It is voluntary
2. You get paid extra money on top of fee for service

Only for med oncs?

 

[Gfunk6]

Only for med oncs?

Naturally

 

[Mandelin Rain]

I'm sure ASTRO is on it.

 

[TheWallnerus]

I'm sure ASTRO is on it.

 

[Mandelin Rain]

This is the issue with bureaucratic institutions, once they get started down the wrong path, they just inexorably march to the conclusion rather than change course to something better.

ASTRO/ACRO/Whoever should be lobbying to scrap the model altogether rather than work on fixing it. It's unfixable. Work closely with them to come up with something that makes sense. Have rad onc participation limited to those who may actually have to use model (i.e. not PPS exempt physicians). Have physician input be FAR less stupid than 100% of cases MUST be peer reviewed prior to start of treatment.

Go for voluntary with financial reward for participation. Like med onc did. Duh.

 

[medgator]

This is the issue with bureaucratic institutions, once they get started down the wrong path, they just inexorably march to the conclusion rather than change course to something better.

ASTRO/ACRO/Whoever should be lobbying to scrap the model altogether rather than work on fixing it. It's unfixable. Work closely with them to come up with something that makes sense. Have rad onc participation limited to those who may actually have to use model (i.e. not PPS exempt physicians). Have physician input be FAR less stupid than 100% of cases MUST be peer reviewed prior to start of treatment.

Go for voluntary with financial reward for participation. Like med onc did. Duh.

ASTRO opposed payment bundles until APM got shoved down everyone's throat collectively.

I see this no differently. ASTRO won't do anything until CMS makes it mandatory and then they will "react" likely they usually do and try to steer the ship after the fact

 

[Gfunk6]

At present, we are kind of stuck in the cycle of creating an APM that everyone (except the Feds) thinks is a piece of ****. ASTRO will do what they can to make the turd "shiny" as others have said. Then, mere days before implementation the emails, texts, and phone calls flood the inboxes of our elected representatives and CMS pulls the plug at the last minute and goes back to the drawing board.

Though this is not sustainable, we can keep this cycle on for as long as possible. The best thing we can do is to include protons in the APM. Protons have a massive lobby and state pension funds (like in TX) include interests in protons and some states have ridiculous proton/population ratios (like in OK). These facts will maximize the chances that the Feds throw the baby out with the bathwater.

 

[BobbyHeenan]

At present, we are kind of stuck in the cycle of creating an APM that everyone (except the Feds) thinks is a piece of ****. ASTRO will do what they can to make the turd "shiny" as others have said. Then, mere days before implementation the emails, texts, and phone calls flood the inboxes of our elected representatives and CMS pulls the plug at the last minute and goes back to the drawing board.

Though this is not sustainable, we can keep this cycle on for as long as possible. The best thing we can do is to include protons in the APM. Protons have a massive lobby and state pension funds (like in TX) include interests in protons and some states have ridiculous proton/population ratios (like in OK). These facts will maximize the chances that the Feds throw the baby out with the bathwater.

This is reasonable.

The big issue I see is that what would be best for the big ASTRO players (proton exemption) looks different than what would be best for the field as a whole (proton also bundled into APM). No way ASTRO would get behind protons being included.

?Maybe the compromise would be including protons with a provision that if randomized trials or "substantial body of evidence" goes on to show improvement there is a yearly review period where more expensive procedures can be "boosted" or given extra $/exemption. In the next few years we are very likely to see the randomized prostate, esophagus, head and neck, and lung data.

I continue to support extra boost of $ and/or exemption of randomized phase II/III trials as well.

 

[Mandelin Rain]

CMS, just give us a ****ing raise already. You're trying to get blood from a stone at this point. Drop pembro reimbursement by 0.5% to pay for it.

 

[Gfunk6]

ASTRO's official statement and analysis of OEM.

 

[iradi8r]

It appears that The EOM includes paying the MO's for total care for a period including radiation. So in effect at risk capitation of a sort, and you can now expect the med onc's to be looking to squeeze us on pricing.

Or am I reading this wrong?

 

[Gfunk6]

It appears that The EOM includes paying the MO's for total care for a period including radiation. So in effect at risk capitation of a sort, and you can now expect the med onc's to be looking to squeeze us on pricing.

Or am I reading this wrong?

You are not reading it wrong, but it appears the details are not final and there is a lot of hashing out to do over the next year.

 

[Fpg1245]

It appears that The EOM includes paying the MO's for total care for a period including radiation. So in effect at risk capitation of a sort, and you can now expect the med onc's to be looking to squeeze us on pricing.

Or am I reading this wrong?

This won’t hold water. It would also mean med oncs cutting back on drugs they give. 1 year of Durva? Can we get away with 6 months maybe? It’ll be disastrous for pharma which is all that really matters.

 

[Lamount]

This is all way above my head... but this seems like a not-so-bright move on the part of CMS, unless they have support that we don't know about. They are essentially making allies of Pharma and RT

 

[BobbyHeenan]

It's like the meme "men will do X instead of going to therapy."

For CMS it's "CMS will do X instead of negotiating drug prices directly with pharma."

 

[fiji128]

It's like the meme "men will do X instead of going to therapy."

For CMS it's "CMS will do X instead of negotiating drug prices directly with pharma."

By current law, CMS can't negotiate prices with pharma. That's what good lobbying can get ya.

 

[Mandelin Rain]

It's so gross that both parties are owned by corporate interests.

 

[BobbyHeenan]

By current law, CMS can't negotiate prices with pharma. That's what good lobbying can get ya.

Exactly.

 

[medgator]

Exactly.

VA can though. Go figure.