The U.S Centers for Medicare & Medicaid Services (CMS) has announced a second cohort for its Enhancing Oncology Model payment demonstration, as well as some updates to the program.
The goals of the Enhancing Oncology Model (EOM), which went live on July 1, are to improve quality and reduce the cost of cancer care with augmented care coordination. While documents on the model do not specifically mention palliative care, several elements of the model align with that care model.
Effective Jan. 1, 2025, CMS will implement some revisions to the program.
“In addition, for both the current and new cohort, CMS will make notable changes to the model, including extending the model by two years, making a higher monthly payment for enhanced services, and establishing a higher threshold for recoupment (the level of spending at which an EOM participant will owe a performance-based recoupment to CMS),” the agency indicated in an announcement.
EOM is a five-year voluntary model, in which participating practices must take into consideration their patients’ preferences and goals for treatment, health equity, social determinants of health and psychosocial health needs.
Participants deliver care in six-month episodes to patients receiving chemotherapy who have one of seven types of cancer: breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma and prostate cancer, according to CMS.
Patients aligned with EOM are to receive 24/7 access to clinicians, patient navigation services and a detailed care plan that includes goals-of-care conversations, discussions of prognosis, treatment options, quality of life, symptom management and psychosocial health needs.
Providers must also screen patients for social determinants of health needs, provide comprehensive, coordinated cancer care and strive for continuous data-driven improvement.
For operators, EOM offers two main avenues for reimbursement, a Monthly Enhanced Oncology Services (MEOS) payment, and a performance-based payment (PBP). Starting in 2025, the MEOS payment will increase to $110 per member, per month, up from $70 in the program’s first year. For dually-eligible patients, the payment for 2025 will be $140.
The PBP payments are linked to spending targets.
“Participants may earn a performance-based payment by meeting a risk-adjusted spending target for their attributed episodes; conversely, they will owe a performance-based recoupment to CMS if total spending in these episodes exceeds a specified percentage of their benchmark amount,” CMS indicated. “For all participants, this threshold for recoupment will increase from 98% of the benchmark amount to 100% of the benchmark amount, beginning for episodes initiating on or after Jan. 1, 2025.”
