CMS recently released the Oncology Care Model (OCM) performance period 1 (PP1) true-up 1 and the performance period 2 (PP2) initial reconciliation. The performance data show some practices may be gaining traction with their success, while others have found it difficult to make progress as CMS continues to refine the payment methodology for the model across performance periods.
This article has been written by Alyssa Dahl, MPH, CPH, manager of Healthcare Data Analytics at DataGen.
More than 2 years into the Oncology Care Model (OCM) program, cohort participants still lack clarity on the program results and how they got there. CMS recently released the OCM performance period 1 (PP1) true-up 1, encompassing 8 months of data after the end of the first performance period, and the performance period 2 (PP2) initial reconciliation, encompassing 2 months of data after the end of the second performance period. The performance data show some practices may be gaining traction with their success, while others have found it difficult to make progress as CMS continues to refine the payment methodology for the model across performance periods.
Two Steps Forward, 2 Steps Back
While some of the participating practices qualified for a performance-based payment (PBP) in the initial reconciliation, they lost it in the PP1 true-up. There were several factors at play here:
While those who achieved a PBP in the initial reconciliation may rue the false sense of security it gave them, these updates to the program methodology will potentially have a positive impact on future performance periods.
Looking for Cause and Effect in PP2 and Beyond
More practices earned a PBP in the second performance period reconciliation compared with the first. A bigger task is for the PBP earners to figure out the precise reasons that led to cost-savings, since the results are not one-size-fits-all across cancer types.
Participants that lost money will need to quickly try and close this gap. In some cases, they may be rethinking pooling arrangements. For example, if some of their practices were able to save, but the pool as a whole did not, this has implications on taking 2-sided risk or exiting the program in September 2019.
Practices look forward to seeing what happens in the PP3 reconciliation at the end of February 2019, since this period will contain many long-awaited methodological refinements, including:
On the Horizon
CMS will assess the most recent results of the first 4 performance periods in September 2019 to identify practices that earned PBPs. At that time, CMS is expected to make a determination on whether practices can continue with 1-sided risk or must choose 2-sided risk. If a practice has not achieved a PBP and is not ready for 2-sided risk, it must leave the program. Practices will also have the recently announced mandatory radiation oncology bundle to contend with next year or the year after. They will be challenged to fine-tune their practice transformation quickly if they are to succeed in either—or both—bundled payment models.