March 21, 2017

Understanding the Recent Oncology Care Model Program Updates

In 2016 the Centers for Medicare & Medicaid Services (CMS) launched a pilot payment and quality incentive program designed to help oncology practices improve the treatment and coordination of care of Medicare patients with cancer, while lowering the overall cost of providing care. This innovative Oncology Care Model (OCM) program recently announced changes to its requirements in a lengthy update to participants. Our team dedicated to OCM here at Cota has helpfully summarized these recent program changes in this post. Skip directly to the OCM program changes here.

Overview of the OCM

The OCM is one of the CMS Innovation Center’s specialty care value-based payment initiatives. The five-year pilot launched with nearly 200 participating providers and 16 commercial payers. The physician practices commit to payment arrangements that incorporate both financial and performance accountability related to the episodes of care for chemotherapy administration to cancer patients. The OCM aims to help oncologists deliver high quality and effective care that follows national standards for treatment, provide better coordination of care and reduce costs to Medicare.

Practices must report specific patient details and quality measurements to CMS through regular reporting of certain data elements. Performance payments will be awarded based on how the practice measures against benchmarks set by CMS based on historical data, geographic adjustments and trended for the period.

Recent Updates to the OCM

In response to provider and vendor feedback, CMS has made some updates to the OCM Data Registry reporting requirements. The following summarizes the changes.

Reduced Frequency of Reporting

Instead of quarterly reporting periods, the OCM will require semi-annual reporting from oncology practices. Each year will contain two reporting periods; the first reporting period spans January 1 to June 30, and the second covers July 1 to December 31. This change aligns the performance periods with the measurement periods.

Extended Submission Deadlines

CMS is extending data submission deadlines to three months following the end of the two new semi-annual reporting periods. The submission deadline for each year's first reporting period is now September 30, and the submission deadline for the second reporting period is March 31 annually. These deadline extensions allow providers additional time to collect the necessary information from their practice systems and perform quality control on all submitted numbers and patient data.

Change in September 30, 2017 Submission Requirements

For the first reporting period of 2017 the data requirements will be reduced. For the submission due by midnight of September 30, 2017, which will cover the period of January through June 2017, the revised reporting requirements include:

  • Five practice-level aggregate quality measure scores (OCM-7, OCM-8, OCM-9, OCM-10 and OCM -11) for Medicare and non-Medicare beneficiary patients with qualifying provider encounters between January 1 and June 30, 2017
  • Staging and clinical data for all Medicare beneficiaries in active episodes on January 1, 2017, or in episodes that were initiated between January 2 and June 30, 2017

This update eliminates the need to submit beneficiary-level data for the OCM Quality Metrics 7-11. For this submission the performance scores and beneficiary level data on OCM Quality Metrics 4a, 4b, 5, 12, 24 and 30 also are removed as a requirement.

Future Submission Requirements

Beginning with the data submission due by March 31, 2018, for the second reporting period of 2017, OCM Data Registry reporting requirements will encompass the following:

  • Practice-level aggregate measure scores for both Medicare and non-Medicare patients in an active episode between July 1 and December 31, 2017
  • Beneficiary-level quality measure data (4a, 4b, 5, 7, 8, 9, 10, 11, 12, 24 and 30) for Medicare beneficiaries in an active episode between July 1 and December 31, 2017
  • Staging and clinical data for Medicare beneficiaries in an active episode between July 1 and December 31, 2017

The March 31, 2018 submission will mark the first time that all Quality Measure and Clinical and Staging data elements being collected for the OCM will be reported back to CMS.

How Cota OCM Helps Providers

In value-based care models such as the OCM, the ability to gather, retrieve, process and share large amounts of structured and unstructured data is critical. Managing all of this data presents challenges that exceed most practices capabilities. Cota OCM can help navigate through the complexities of performance-based payment programs such as the OCM.

Cota OCM automates the process of collecting data, making calculations and reporting results. It also offers providers guidance based on data entered, which helps them optimize performance and maximize payments.

Cota OCM facilitates the collection of data in four main ways:

  • Automatically extracting data directly from EHRs for all practice-reported OCM quality measures
  • Calculating all required quality measures automatically and preparing summary data for exporting or submitting to the CMS registry
  • Analyzing program performance for remediation and recommendations for improvement across quality measures
  • Optimizing performance to maximize future financial incentives

Learn more about how Cota OCM can help participating providers in the short video below, and feel free to reach out to our team to see how we can help.

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