Value-Based Care

The Network’s commitment to the evolution of value-based care is demonstrated by our participation in the Oncology Care Model (OCM), a voluntary demonstration program from the Center for Medicare and Medicaid Innovation (CMMI), running from 2016-2021. The OCM required participating practices to manage all aspects of a cancer patient’s care delivery (including prescription drugs and emergency department visits) for a 6-month episode. Over the duration of the 6-year model, Network practices enrolled more than 130,000 unique patients and saved the Medicare program over $330 million relative to benchmark prices. Since 2016, Medicare OCM patients treated in these practices in The Network realized a 37% reduction in inpatient stays, 18% decrease in emergency room visits, and a 6% increase in access to hospice >3 days before end of life.

Additional Resources

• Oncology Care Model – Six Years Later (Blogpost)
• Network letter to CMMI on the Third Annual OCM Evaluation Report
• Network comments on Oncology Care First RFI

The RO Model aims to test whether prospective, site neutral, episode-based payments to physician group practices and hospital outpatient departments for radiotherapy episodes of care would reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries. The Model’s episode payment is designed “to give radiotherapy providers and suppliers greater predictability in payment and greater opportunity to clinically manage the episode, rather than being driven by fee-for-service (FFS) payment incentives.” Radiation therapy providers and suppliers have been randomly selected for participation based on Core-Based Statistical Areas (CBSAs), and 33 sites from 14 practices in The Network were included in the zip codes selected for participation.

In November 2021, the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI) issued a final rule making slight revisions to the Radiation Oncology (RO) Model, including updating the model’s base rates, removing liver cancer and brachytherapy, and lowering the discounts from 3.75% to 3.5% for the professional component and 4.75% to 4.5% for the technical component, and adopting an extreme and uncontrollable circumstances policy. The RO Model was set to begin on January 1, 2022.

At the same time, radiation oncology was looking at a waterfall of Medicare payment cuts set to take effect on January 1, 2022, including the expiration of the temporary 3.75% payment bump and the 2% sequester moratorium, as well as cuts related to policy changes in the CY 2022 Medicare Physician Fee Schedule. In its comments to CMS on the latest iteration of the RO Model, The Network urged CMS to “consider the holistic impact of cuts stemming from the RO Model, the PFS, and the COVID-19 pandemic to freestanding oncology practices to ensure the Model doesn’t lead to further consolidation.” The Network also joined industry stakeholders in calling on Congress to address these cuts before the end of the year.

On December 9, 2021, Congress passed a special Medicare package that mitigated many of these payments cuts and delayed the RO Model until January 1, 2023. Shortly thereafter, in April 2022, CMS announced that the RO Model would be delayed indefinitely. 

The Network will continue working with CMS and Congress to advance more meaningful practice transformation and maintain the viability of community cancer practices.

Additional Resources:

• The US Oncology Network letter to CMS on the Proposed Indefinite Delay
• Stakeholder Letter to President Biden on Radiation Oncology Cuts
• The US Oncology Network Letter to CMS on the Revised RO Model (CY22 OPPS Proposed Rule)
• The US Oncology Network Letter to CMS on the Finalized RO Model
• The US Oncology Network Statement on the Finalized RO Model
• The US Oncology Network Comment Letter to CMS on the Proposed RO Model