{"title":"The Key Factors Driving Low Participation in the Enhancing Oncology Model","authors":"Theresa Dreyer","doi":"10.25270/jcp.2024.01.01","DOIUrl":null,"url":null,"abstract":"This study investigates the challenges leading to a substantial decline in participation among academic oncology practices within the Enhancing Oncology Model (EOM), introduced as a successor to the Oncology Care Model (OCM) by the CMS Innovation Center. Analyzing the withdrawal of 14 practices from the EOM, previously part of the OCM Collaborative, three primary factors are identified: immediate downside risk in a context of narrow provider margins, inadequate risk adjustment failing to appropriately account for drug costs, and onerous reporting burdens for extensive clinical data. Under the EOM, immediate downside risk for seven specified cancers diverged significantly from the OCM’s upside-only risk structure, posing financial challenges for practices. Inadequate risk adjustment, particularly the omission of crucial clinical data, raised concerns about the model’s focus on drug costs without considering essential patient-specific variables. The study also highlights the burden of reporting requirements, exacerbated by reduced enhanced services payments, impacting practices financially. To address these challenges and encourage EOM participation, policy options are proposed. These include reconsidering financial risk levels, refining target price methodology to incorporate clinical data, and reducing reporting burdens by aligning data requirements with EOM financial and quality methodologies. These adjustments aim to strengthen the EOM, fostering more accurate performance measurement and incentivizing high-quality patient care delivery in oncology practices.","PeriodicalId":507805,"journal":{"name":"Journal of Clinical Pathways","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Pathways","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.25270/jcp.2024.01.01","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
This study investigates the challenges leading to a substantial decline in participation among academic oncology practices within the Enhancing Oncology Model (EOM), introduced as a successor to the Oncology Care Model (OCM) by the CMS Innovation Center. Analyzing the withdrawal of 14 practices from the EOM, previously part of the OCM Collaborative, three primary factors are identified: immediate downside risk in a context of narrow provider margins, inadequate risk adjustment failing to appropriately account for drug costs, and onerous reporting burdens for extensive clinical data. Under the EOM, immediate downside risk for seven specified cancers diverged significantly from the OCM’s upside-only risk structure, posing financial challenges for practices. Inadequate risk adjustment, particularly the omission of crucial clinical data, raised concerns about the model’s focus on drug costs without considering essential patient-specific variables. The study also highlights the burden of reporting requirements, exacerbated by reduced enhanced services payments, impacting practices financially. To address these challenges and encourage EOM participation, policy options are proposed. These include reconsidering financial risk levels, refining target price methodology to incorporate clinical data, and reducing reporting burdens by aligning data requirements with EOM financial and quality methodologies. These adjustments aim to strengthen the EOM, fostering more accurate performance measurement and incentivizing high-quality patient care delivery in oncology practices.