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MACRA 2.0 and Beyond: Preparing Your Practice to Meet the Quality and Reporting Challenges

Surabhi Dangi-Garimella, PhD
At the 2017 American Society of Clinical Oncology Annual Meeting, oncologists heard from fellow experts on the best way to navigate this daunting payment reform challenge.
Another payment model that stemmed out of a collaboration between McAneny’s Innovative Oncology Business Solutions and ASCO is the Patient-Centered Oncology Payment Model (PCOP) model. In a recently published article in The American Journal of Managed Care®, McAneny and her coauthors explained that PCOP offers a chemotherapy or immunotherapy episode of care with 3 levels of reimbursement, leading from basic fee-for-service care to monthly payments to overall care bundles. A practice will get a 1-time $750 payment for each new patient, a $200 monthly fee during the 6-month episode, and a $50 care management payment during the active monitoring phase that can last up to 6 months after treatment ends.

What PCOP aims to achieve is,
  • Reduce avoidable readmissions
  • Ensure the practice follows appropriate use criteria for drugs, tests, and imaging
  • The practice receives higher payments than existing reimbursement margins

The pilot, to data has seen,
  • 11 total hospitalizations (4.1% monthly hospitalization rate)
  • 41 triage encounters, with 18 same-day appointments and 3 emergency department visits avoided
  • 142 active chemotherapy months, with a 92.2% pathways complians

McAnany shared her worry with the 2-sided risk offered under OCM. Her practice ran a simulation using 290000 episodes from COME HOME and then randomized them. “We found that our COME HOME practice, even with all its transformations and efficiencies, has only a 3% chance of making any money.” The patient population is too small to meet the actuarial risk associated with these payment models.

“I am even concerned with taking 1-sided risk with these APMs,” McAneny said. “We need to talk to CMS to devise a more realistic system and develop targets that we can achieve.”

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