CMS’ Oncology Care Model, which ran from 2016 to 2022, is estimated to have resulted in an $639 million net loss to Medicare, according to a study published March 25 in JAMA Network Open.
Under the Oncology Care Model, physician practices participated in payment models that held them financially and clinically accountable for care episodes tied to chemotherapy treatment for cancer patients. CMS has since launched a second payment model, the Enhancing Oncology Model, which is expected to conclude in 2030.
Researchers from Lebanon, N.H.-based Dartmouth Cancer Center and Boston-based Harvard Medical School used care episode data of Medicare beneficiaries from a baseline period of January 2014 to January 2016, and an intervention period of July 2016 to June 2022, and analyzed whether the Oncology Care Model reduced spending or improved care quality for chemotherapy patients.
Here are five things to know from the study:
- The study population was composed of 202 Oncology Care Model-participating practices and 534 comparison practices. Researchers evaluated data from more than 1.5 million Medicare beneficiaries and about 3.67 million care episodes across both practice types.
- Between the baseline and intervention periods, total payments increased from $29,206 to $36,190 for Oncology Care Model care episodes, and from $28,788 to $36,388 for care episodes at comparison practices.
The Oncology Care Model was associated with a $616 decrease in spending per episode of care.
- Total payment reductions increased over time, with “statistically significant” spending reductions seen for Medicare Part A and Part B, the study authors wrote.
- There were no differences in hospitalization rates, emergency department visits or care quality between the two practice groups.
- The enhanced service and performance-based payments associated with the Oncology Care Model exceeded overall savings, resulting in a $639 million net loss.
Read the full study here.
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