While the final number of EOM practices will be fewer than the numbers in the OCM, the presence of Tennessee Oncology, Texas Oncology, and Northwest Medical Specialties will ensure participation of key leaders who succeeded in the OCM and have weighed in on what's needed in its replacement.
This article was updated July 10.
The Enhancing Oncology Model (EOM), a new Medicare alternative payment model that started July 1, has attracted practices that are home to well-known physician leaders who succeeded at operating in the Oncology Care Model (OCM), according to information provided by the practices or their networks.
Tennessee Oncology, a 108-physician founding practice of the OneOncology network, signed on for the 5-year EOM pilot, a spokesperson for the network confirmed this week. The Cancer and Hematology Centers, a OneOncology network member with multiple locations in Western Michigan, will also participate.
Twelve practices from The US Oncology Network, including Texas Oncology, a 530-phyisican practice with locations statewide, will participate in the EOM, a spokesperson confirmed. Other practices in the network that are participating are:
Sibel Blau, medical director of Northwest Medical Specialties, PLLC, and president and CEO of the Quality Cancer Care Alliance, confirmed in an email that her practice would be participating in the EOM.
There has been considerable speculation how many practices would sign on to the EOM, given the changes made to the model relative to its predecessor, the OCM, which operated from 2016 until 2022. Notable changes include: smaller monthly payments to practices to cover required services to eligible patients, a reduction in the number of Medicare cases eligible for the model, and the changes in risk structure, which require practices to take on downside risk from the first day of the model.
On June 27, the Center for Medicare and Medicaid Innovation (CMMI) published an update stating that 67 practices would participate in the EOM; however, it is known that that some practices on that list had dropped out before the June 30 enrollment deadline. For example, a few smaller practices in The US Oncology Network included on the June 27 list were not on the final list provided to The American Journal of Managed Care® (AJMC) by a network spokesperson. A large practice that is part of the OneOncology network told CMMI on June 28 it would not be participating, after the practice appeared on the list.
Although the final number of EOM participants is not known, it appears the model will attract possibly half the 122 practices enrolled in the OCM when it ended in June 2022.
However, the presence of Texas Oncology, Tennessee Oncology, and Northwest Medical Specialties ensures that the EOM will include several visible leaders who wrote and spoke frequently on the OCM, and more recently on the potential challenges of the EOM.
Oncologists include Stephen M. Schleicher, MD, MBA, chief medical officer of Tennessee Oncology; and Lalan Wilfong, MD, senior vice president of Payer and Care Transformation at The US Oncology Network, whose home practice is Texas Oncology.
OneOncology’s Aaron Lyss, MBA, director of Strategic Payer Relations, is also a frequent OCM and EOM commentator, and he joined Wilfong for a panel discussion on the topic at the recent annual meeting of the American Society of Clinical Oncology. Lyss was previously with Tennessee Oncology, which estimated it saved Medicare $5 million during the last performance period of the OCM.
Another key nononcologist working with multiple practices in the EOM is Stuart Staggs, MSIE, who is director of Strategic Programs for McKesson. Staggs has estimated that the network practices saved Medicare $337 million compared with benchmarks during the OCM.
In a blog post, Wilfong and Staggs said more than 1000 physicians, or 70% of those in The US Oncology Network, will be EOM participants.
Blau, in comments during a panel discussion at QCCA's annual meeting, said that despite the challenge of joining EOM with no run-in period, there was also risk in not participating, given the belief among many oncologists that CMS may someday require practices to take on risk.
AJMC has reached out to additional practices on the June 27 list for confirmation they are participating in the EOM. CMMI said in a June 30 email to AJMC that it would provide an update with final EOM participants during the first week of the EOM.