How Do Oncology Practices Affect Mandatory Bundled Payment Models?

How Do Oncology Practices Affect Mandatory Bundled Payment Models?

One of the new bundled payment models from the Centers for Medicare & Medicaid Services (CMS) that is the Oncology Care Model has increased the interest and doubled the participation numbers among healthcare providers as many medical organizations participating than initially expected.

Research-based study shows that many organizations are experimenting with value-based payment models that highly assure to scale up the challenging goals of controlling costs and easing access to advances in treatment.

The value-based payment models under experiment in the commercial market are:

  1. Financial incentives for adhering to clinical pathways
  2. Patient-centered medical homes
  3. Bundled payments
  4. Specialty accountable care organizations

Moreover, CMS has recently launched the Oncology Care Model, a 2-part payment system, which resembles a PCMH and a bundled payment model. Most of these models intend drug costs; with a common element in all the value-based reimbursement models for oncology includes a priorly drug spending reduction goal. These models focused to reduce prescription drug spending and utilization as medication costs count to be the greatest one in the episode of cancer.

To attain the financial incentives, providers engaging with the model had to stick to the pathway between 70 and 85 percent of the time. This adherence range also gave providers ease for varying essential care practices as per patient characteristics, preferences and advanced treatments.

The outcome of the clinical pathway model was noteworthy healthcare cost reduction, majorly for drug expenses and healthcare utilization services. Drug costs were found to be reduced between 5 and 38%.

Similarly, bundled payments also emerged as a common way to reduce cancer care costs. The interviewees utilizing bundled payment models explained that drug costs were an essential part of the bundle which roofed services somewhere between 1 -2 years.

As the response to the new CMS proposal, according to the Community Oncology Alliance (COA), to step up with a mandatory bundled payment model for radiation oncology may escalate CMS authority with a probability of harm to be caused to the cancer patients. The mandatory models always either compel providers to go for new models or reimbursement of care. This can disturb and confuse the patients undergoing cancer treatments and other serious diseases to be dejected whilst they need the calmness and care importantly.

There should not be any government based imposition or testing with the patient undergoing cancer treatment moreover when the physicians are not involved in any model development. It would be beneficial for the voluntary provider’s participation if the alternative payment model in which he is participating will be reasonable and would advance value-based care.

Also, it is a thought of worry that the mandatory Radiation Oncology Model may mask the positive remarks achieved under CMMI’s Oncology Care Model (OCM).

The oncology bundled payment models resulted in the following cost and utilization reductions:

  • 32% less emergency room visits
  • 19% decrease in inpatient days
  • Drug costs constancy after a significant increase between 16 and 19 % per year

Effects of Oncology Care Model

The growing participation among cancer facilities in OCM is good to see in the transition to value-based payment particularly for bundled payments and the future of healthcare.

The Oncology Care Model along with other CMS bundled payment programs are becoming more popular as more healthcare providers continue to transition to value-based care reimbursement. Private payers that haven’t yet should look to invest in bundled payment models to improve the quality of care and reduce spending.

Well, it is not easy to detect considerable impacts on quality of care and cost because of the restricted performance episode of the model, but stated that the opening results are hopeful.

It needs a meticulous study to understand the way that the mandatory models will affect the significant investment and progress achieved in other ongoing quality and value reform projects.

One Reply to “How Do Oncology Practices Affect Mandatory Bundled Payment Models?”

  1. Robert


    Awesome post! Keep up the great work! 🙂

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