OCM, Other APM Timelines Extended Due to COVID-19

June 3, 2020
Mary Caffrey
Mary Caffrey

CMS Administrator Seema Verma announced the update today in a blog post in Health Affairs.

The Center for Medicare and Medicaid Innovation (CMMI) today extended the Oncology Care Model (OCM) for a year and granted flexibility for timelines on other alternative payment models (APMs) due to the havoc created by coronavirus disease 2019 (COVID-19).

CMS Administrator Seema Verma announced the update today in a blog post in Health Affairs, saying that while health care transformation has made great strides, “when it comes to a pandemic of the proportion we’re now experiencing, as part of ensuring that value-based payments are sustainable, the models must be adjustable to address the uniqueness of the current situation.”

APMs were modified on an individual basis, based on principles that Verma outlined, which included using flexibilities already in the model, minimizing risk to model participants and the Medicaid program, limiting implementation delays, and “aligning with national value-based and quality payment programs.”

The adjustments cover several high-profile APMs, and vary from no change to the Bundled Payment for Care Improvement Advanced program (BPCI-A), to the decision to extend year 5 of the Comprehensive Care for Joint Replacement (CJR) program through March 2021.

A pair of models for accountable care organizations (ACOs), the Next Generation ACO model and the Medicare ACO Track 1+ Model, will see several adjustments to the financial methodologies. The Medicare model will have a voluntary extension through December 2021, and the Next Generation model will have an overall extension through December 2021.

But the yearlong extension of the OCM is newsworthy for what will apparently not happen. CMMI unveiled a possible successor plan, Oncology Care First (OCF), that was set to take effect January 1, 2021. OCM will extend for a year through June 2022. The announcement does not mention the OCF, and reports changes to financial modeling that include:

  • An option for OCM practices to forgo upside and downside risk for performance periods affected by the pandemic, defined in the document as the public health emergency.
  • For practices that stay in 1- or 2-sided risk during performance periods affected by the pandemic, any episodes of care affected by COVID-19 can be removed from reconciliation for those periods.

This latter part is important, given recent evidence—including data presented last weekend at the American Society of Clinical Oncology—that patients with cancer face higher mortality risk if they contract COVID-19, especially if they have lung or other thoracic cancers and if they have received chemotherapy in the past 90 days.

Kashyap B. Patel, MD, of Carolina Blood and Cancer Care Associates in Rock Hill, South Carolina, who is vice president of the Community Oncology Alliance (COA), said in an interview that CMMI had responded favorably to a letter he and Lalan S. Wilfong, MD, of Texas Oncology had written on COA's behalf seeking the extension.