ASCO and PhRMA Critical of the CMS Oncology Care Model

One of the criticisms, which came from ASCO, points to the absence of consideration for patient heterogeneity that can result in physicians being penalized for providing patient-centered treatment.

CMS will experiment with moving cancer care into a value-based system with a new multi-payer payment and care delivery model. However, the model, developed by the Center for Medicare & Medicaid Innovation, is drawing criticism from stakeholders in oncology care, who say it could adversely impact optimal patient care by placing oncologists at risk for chemotherapy drugs.

“It builds on what we think is a broken fee-for-service system,” says Blase Polite, MD, chair of the American Society of Clinical Oncology (ASCO) Government Relations Committee and an oncologist at the University of Chicago. “It enshrines all the problems in fee-for-service, and it doesn’t give practices enough flexibility.”

Under the 5-year experimental Oncology Care Model (OCM), which will include nearly all cancers, participating practices will receive a care coordination fee totaling $160 for each 6-month period the patient is in chemotherapy. The fee comes on top of regular fee-for-service payments.

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