CMS has attempted to tailor ACOs to meet a variety of needs and levels of risk, depending on where parties are in their knowledge level of payment reform.
Tremendous consolidation of re­maining independent oncology practices is very likely under scenarios painted by panelists at the 4th annual meeting of Patient-Centered Oncology Care, pre­sented by The Ameri­can Journal of Managed Care.
The closing panel discussion of the 2-day event brought together an independent prac­tice representative and a former director of medical policy devel­opment for the FDA. CMS has a strong desire to make accountable care organi­zations (ACOs) work, but there are many variables, and panelists said further ex­perimentation with this form of care could have the effect of driving physi­cians out of fee-for-service (FFS) and into Medicare Advantage, where group health programs administer Medicare payment.
However, the degree to which oncol­ogy practices will participate in this migration is unclear because many of them are falling into the gravitational pull of expanding hospital systems, the panelists said. Yale-New Haven Hospi­tal is an example of a growing, all-en­compassing conglomerate, said partici­pant Ted Okon, executive director of the Community Oncology Alliance (COA): “What’s called Jaws in Connecticut is also known as Yale. They’ve bought up everything in the entire state.”
CMS has attempted to tailor ACOs to a variety of health organizations so that each is comfortable with the level of risk it is undertaking though par­ticipation. The Medicare Access & CHIP Reautho­rization Act, for example, offers the choice of par­ticipation in an alterna­tive payment model or FFS. Similarly, the Oncol­ogy Care Model, scheduled for launch in spring of 2016, allows for innovative forms of reimbursement.
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