Cancer Medicare P4P

Did the Oncology Care Model produce cost savings?

The answer is ‘yes’, but the magnitude of these savings are relatively small and more than offset by additional OCM program costs. Keating et al. (2021) writes:

In this exploratory difference-in-differences study of Medicare fee-for-service beneficiaries with cancer undergoing chemotherapy (483 310 beneficiaries with 987 332 episodes treated at 201 OCM participating practices and 557 354 beneficiaries with 1 122 597 episodes treated at 534 comparison practices), OCM was associated with a statistically significant relative decrease in total episode payments of $297 that was not sufficient to cover the costs of care coordination or performance-based payments. There were no statistically significant differences in most measures of utilization, quality, or patient experiences.

On average, the cost of an OCM episode was about $30,000. Thus, implementation of OCM resulted in a 1% cost savings. However, these savings in Medicare claim cost payments were offset by additional Monthly Enhanced Oncology Services payments of ($704). In short, implementing OCM cost Medicare about $400 per patient, or a little over a 1% increase in episode cost.

Leave a Reply

Your email address will not be published. Required fields are marked *