In the past, I have written about the Enhancing Oncology Model (EOM), including an overview of the EOM program as well as a more detailed review of EOM’s payment methodology. A new paper in JAMA Health Forum by Kocher and Adashi (2023) describes their perspective on the EOM program.
First, they provide a nice overview of the program:
The EOM is a voluntary 6-month, 2-sided, risk-based payment model for clinicians caring for Medicare patients with 7 common cancer types beginning on July 1, 2023, for 5 years. The EOM provides practices with $70 per patient per month to fund a set of activities that are focused on enhanced patient experience, quality improvement, and cost saving. Clinicians receive an additional $30 per patient per month for dually eligible patients and may earn up to a 4% bonus if their total cost of care is below an estimated cost benchmark and they achieve quality targets. Additionally, clinicians must make a performance-based recoupment payment of up to 2% if the total cost of care exceeds the benchmark.
The authors bring up the fact that EOM’s predecessor–the Oncology Care Model (OCM)–was not particularly successful based on the evidence.
…the OCM model was not cost-effective, and Medicare lost $377 million testing this model based on analyses of the initial 5 performance periods [See Hansol 2021, Keating 2021] Despite payments for care coordination, no change was noted in emergency department visits, hospitalizations, and quality of care. Small end-of-life cost savings were derived from a 1% reduction in hospitalizations. Patient satisfaction was found to be unchanged. The OCM did generate cost savings for some cancer types, including breast cancer, lung cancer, colorectal cancer, and lymphoma.
EOM is a voluntary program. The authors voice concern about physician participation for four reasons: (i) monthly care management payments are lower than under OCM, (ii) cost savings benchmarks will be difficult to achieve, (iii) physicians will incur downside financial risk if costs are above predicted levels and (iv) EOM imposes additional reporting and service requirements., and (
…EOM offers clinicians less of an economic incentive to participate since monthly payments are lower and the knowledge from the OCM is that exceeding the savings benchmark will be hard. While some savings were generated for specific cancer types during the OCM performance periods studied, the savings ranged from 2.2% for high-risk breast cancer to 3.2% for lung cancer—both of which are below the 4% bonus payment threshold set by the EOM…
[Additionally] Clinicians must offer 24-hour/7-day access, care navigation, and care planning and adhere to evidence-based guidelines, collect patient-reported outcomes data, perform social needs screening, collect data on health equity and quality improvement, and use a certified electronic medical record. While most practices likely already offer most of these services because they were also OCM requirements, additional costs may be incurred to ensure compliance. If a practice needs to make investments to meet these requirements, they may not be cost-effective for practices with small numbers of eligible patients
We will see in the coming years how well EOM is able to attract oncologists to participate in the EOM program.
- Kocher RP, Adashi EY. A New Approach to Cancer Bundled Payments in Medicare—The Enhancing Oncology Model. InJAMA Health Forum 2023 Jan 6 (Vol. 4, No. 1, pp. e224904-e224904). American Medical Association.
- Hassol A, West N, Newes-Adeyi G, et al. Evaluation of the Oncology Care Model: performance periods 1-5. January 2021. https://innovation.cms.gov/data-and-reports/2021/ocm-evaluation-pp1-53.
- Keating NL, Jhatakia S, Brooks GA, et al; Oncology Care Model Evaluation Team. Association of participation in the Oncology Care Model with Medicare payments, utilization, care delivery, and quality outcomes. JAMA. 2021;326(18):1829-1839. doi:10.1001/jama.2021.1764