Most Practices Not Joining Enhancing Oncology Model, Survey Finds

Most oncology practices are not planning to participate in the Enhancing Oncology Model (EOM), citing concerns about the risk arrangements and inadequate incentive payments, a survey from the Community Oncology Alliance (COA) found.

EOM is a five-year voluntary model set to begin on July 1, 2023. The model aims to improve care coordination in oncology care and reduce program spending under Medicare fee-for-service. Participants will take on financial and performance accountability for episodes of care surrounding systemic chemotherapy administration in exchange for payment incentives.

The COA survey was conducted from May 1 to May 19, 2023, and included responses from 137 practices, most of which were private practices.

Around 60 percent of respondents (83 practices) had participated in the Oncology Care Model (OCM), the previous oncology payment reform model from the Center for Medicare and Medicaid Innovation (CMMI). However, 71 percent of respondents (91 practices) said they would not participate in the EOM.

Nearly 65 percent of practices submitted an EOM letter of intent to CMMI, but only 29 percent plan to participate.

The main reason respondents cited for not participating was the model’s unpredictability. Practices were also concerned about unpredictable drug prices and the immediate entry into two-sided risk arrangements.

Practices cited inadequate monthly enhanced oncology services (MEOS) payments as another reason for not participating. According to respondents, the incentive payments are too low for a model that requires practices to do more but receive less compensation.

In addition to low reimbursement rates, practices said they don’t want to take the chance of hurting their operations by joining a model where CMMI will not absorb a part of the risk while practices get acclimated to participation.

“Value-based care is the future of healthcare, and community oncology practices are eager to bring the latest and greatest care to their patients,” Judith Alberto, MHA, RPh, BCOP, director of clinical initiatives at COA, said in a press release. “However, practices cannot do this when the barrier to entry and cost of participation potentially endangers the quality of care they provide, as well as the future stability of the practice.”

Practices who plan to participate in the EOM said that the model will help position them to participate in other value-based care models from other payers. Additionally, they said the model offers a framework to provide quality cancer care.

Respondents plan to join the model because they want to be a leader in payment reform, they “want a seat at the CMMI table,” and they experienced success in the OCM and expect similar results in the EOM.

Both practices planning to participate in EOM and those who are not noted several areas where the model could be improved. Participating practices said two-sided risk should be optional or phased in and there should be increased transparency around episode target prices. In addition, they would like to see improved intervals between CMMI feedback reports.

Those who do not plan to participate said MEOS payments should be increased to a minimum of $150. They also supported the idea of allowing up-sided participation for at least one year and eliminating the downside risk option.

“The COA survey should serve as a red alert to CMS and CMMI that the success of the EOM is at risk,” said Shiela Plasencia, director of practice support at COA. “While it is good that some practices are predicting success in the EOM, that is far from certain. Unfortunately, the downside risk to practices, should this model go wrong, is far too great. CMMI must address the concerns of the majority of practices to ensure widespread success.”