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“Surprisingly, or maybe not surprisingly, the communi- ty-based ones are doing a better job of controlling the costs than the hospital-based ones,” Saunders said. “And we see ones [in which] there is a big difference between those that use organized care pathways [and] ones that don’t.”

The panelists concluded by discussing what is next in the OCM, which is scheduled to eventually shift to 2-sided risk. Originally, the model called for 20% downside risk, which is the stop-loss limit, but CMS recently brought the risk down to 8%. Although that is better for practices, Lyss said it was the difference between “completely absurd to 50% as absurd but still absurd.”

That said, Tenessee Oncology has been meeting frequently since CMS announced the change, and the practice believes that the economics of the new arrangement look better not just for Tenessee Oncology but for many of the practices. The organization has figured out that if it just matches its current perfor- mance, it will stand to do better in the 2-sided risk arrangement.

However, for many practices, the stop-loss adjustment is not enough, Saunders acknowledged.

“It’s still a level where if you really think your practice is going to get anywhere near that stop-loss, you’re not going to do that 2-sided risk arrangement,” he concluded. “It’s just a nonstarter.”

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