Dr Ray Page Discusses the Surprise of the First OCM Results
Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders and chair-elect of the American Society of Clinical Oncology’s (ASCO) Clinical Practice Committee discusses the first results of the Oncology Care Model (OCM) and ASCO’s top legislative priorities.
The American Journal of Managed Care®: With first results of the OCM now available, what has been the reaction from OCM-participating physicians in the community on the first performance period? Ray Page, DO, PhD: My group, I’m a participating physician of OCM, so I’m one of the 197 practices, or somewhere around that number that is participating in OCM. And, in general, when you look at the practices that are participating in OCM, these are the most sophisticated practices that are out there. These are not your average, run-of-the-mill oncology groups that are out there. These are the practices that felt like we had enough in place to be able to take on an alternative payment model like OCM. And, so, we came together and became engaged in OCM, and I think all of us really wanted the initials results of our OCM to be good. We wanted to be successful. We wanted it to work for us. Yet, when we got our first reconciliation report, the vast majority of the practices were in the red. We turned out negative. And there’s only a minority of the practices that actually had a positive profit margin.
So, currently, we’re in the throes of going through deep investigation and looking through all of our numbers and the stats, and the calculations and the methodologies, and it’s very, very complex. The practices have found some mathematical errors and mathematical flaws in the calculations and just the way that certain cases can be attributed to the episodes of care and how the practices can get scored. And there are certain incentive factors, and so forth, that don’t quite make sense when you’re doing the calculations.
There’s a lot of variables there that it doesn’t take much change in a patient population and the way that your practicing within that patient population, it doesn’t take much movement or change in that constituency of those groups in order to make significant changes on whether you’re going to be positive or negative in the OCM. So, I think, we’re all in the middle of analyzing this and trying to work with CMMI [Center for Medicare and Medicaid Innovation] to try to see if there are some solutions that we can create in the short term. I think, we’re hopeful to see if they will expand the reporting period for a period of time to allow us to make some adjustments, to correct some of the errors, and give us more time to try to make this work, because, as you know, the end game of OCM is to ultimately have the practices be at a point where they will be willing to shoulder a 2-sided risk model. But, I can tell you, my practice and the majority of practices right now, if they’re in the red, they have no incentive to engage into a 2-sided risk model, where you are already in the negative. So, there’s a little bit of work to do with the current OCM model.
Now, along those lines, there’s entities like COA [Community Oncology Alliance], who has an OCM version 2, that has some differences of models. And then ASCO is also working on a second-generation OCM, basically centered in ASCO’s Patient-Centered Oncology Payment Program, the PCOP Program. And within that, it implements some triage pathways and treatment pathways as methods of compliance in order to get better control over some of the chemotherapy drug usage and the hospitalization usage that we have. I think there’s some good elements in both the COA model and the ASCO model that can actually be implemented as part of a second generation of the OCM to where we can ultimately have an alternative payment model that can work for all of us, in order to deliver that value-based oncology care, where you have the best outcomes and the highest quality of outcomes at the most affordable price.
The American Journal of Managed Care®: What other the major legislative issues are affecting community oncologists that are top of mind for ASCO? Ray Page, DO, PhD: you can kind of look at that at the state level and the national level. And ASCO is really working with all the state oncology societies—there’s a state affiliates council, which creates a grassroots effort with reporting significant state society issues that are occurring at the state level that are affecting cancer care and cancer delivery at the states. So, there’s a number of areas that are occurring at the state level that ASCO is working on and these include such things as insurance parity for oral cancer drugs and the opioid epidemic and the right-to-try legislation, and other policies such as step therapies with formularies, pharmacy benefit managers and their control of the chemotherapy drugs that are distributed. And then just dealing with insurance companies and their prior authorizations and just working with trying to come up with mechanisms of being able to prescribe care without having the excessive administration burdens that exist at the state level in a practice.
On the federal level, ASCO continues to work very hard to shift into that value-based reimbursement model. We continue to work hard on the nuances of MACRA [Medicare Access and CHIP Reauthorization Act], with the MIPS [Merit-based Incentive Payment System] and the QPP [Quality Payment Program] and OCM. And, so, as it stands right now, you’ve got 197 practices participating in OCM as an alternative payment model and ASCO is working with us to try to correct the issues there. But, still, the majority of oncology practices all across the United States are still subject to the MIPS, QPP rules that are out there. And ASCO has done a tremendous amount of work with that over the years in order to try to have certain elements of those calculations and the methodology to put oncologists on par with all the other specialties and subspecialties out there. We did part of that by taking the Part B drugs that we prescribe every day in the office, the chemo drugs, taking that out of the equation so when you’re comparing physician performance, you’re comparing apples to apples and oranges to oranges.
And ASCO also continually wants to support that the NIH [National Institutes of Health] continue to have good funding for research. And, fortunately, with the latest budget bill that came out, there was additional funding that occurred for the NIH. So, we’re happy for the work with hour lobbying efforts on that.