Most Community Oncology Practices Give Thumbs Down to Enhancing Oncology Model, Survey Finds

A majority of practices do not plan to participate in the Enhancing Oncology Model (EOM) when it launches next month, according to survey results released today by the Community Oncology Alliance (COA).

Overall, 71% of the 137 practices that answered the survey do not plan to participate, with the EOM requirement that practices immediately take on 2-sided risk cited as the top reason.

The EOM, announced in July 2022 during the final days of its predecessor, the Oncology Care Model (OCM), has a similar framework as the early alternative payment model for oncology in Medicare, but there are key differences in reimbursement and especially in practices’ requirements to take on risk.

Even practices that have said they plan to pursue EOM after success in the OCM have said they believe a small practice lacking experience with payment models would find the EOM daunting.

They survey found that other major factors in driving the practices’ decisions on the EOM were the “unpredictability of the EOM and drug prices,” and inadequate monthly payments from Medicare to cover required services such as navigation and 24/7 access to health records—which were part of the OCM—along with new services.

Survey results and the reasons why practices fear moving forward are consistent with feedback given at professional meetings and in interviews with The American Journal of Managed Care®. This weekend, an informal poll taken during a session at the American Society of Clinical Oncology (ASCO) showed that most attendees remained unsure about the EOM less than 4 weeks from the July 1 start date.

Hesitation From the Start

After the EOM was announced in June 2022, COA has warned the Center for Medicare and Medicaid Innovation (CMMI) about several features that might deter practices from signing up, even if they had seen success in the OCM. The group noted it collected data from its members after the announcement.

By April, COA Executive Director Ted Okon, MBA, told a meeting of the Quality Cancer Care Alliance that he had warned CMMI officials that without changes, most practices would not sign up.

CMMI agreed to make some adjustments, which were published May 1. And COA surveyed its members from May 1 to May 19 about its plans for EOM participation and concerns with the program. However, 2 key elements did not change:

• Unlike the OCM, which allowed practices an extended period to learn the finer points of the model before taking on 2-sided or “downside” risk, EOM asks practices to assume risk from the first day. In addition, commentators have observed that the EOM offers a very narrow financial lane between success and a zone where penalties would be required.
• The OCM offered practices $160 per patient per month to provide a list of required services; this is cut to $70 for most patients and $100 for those who also qualify for Medicaid. Besides services required in the OCM, the EOM calls on practices to take on new tasks, including electronic patient-reported outcomes and collecting data on health related social needs.

What the Survey Found

Among the 137 practices that took part in the survey, 61% (83 practices) had participated in the OCM, and 20% (28 practices) had previously participate in 2-side risk models. Survey results showed:

• Among the participants, 118 are private community practices, 10 are hospital based, 7 are university based, and 2 are unknown.
• 71 of the 137 practices do not plan to join the EOM.
• 64%, or 88 practices in the survey, submitted a letter of intent to CMMI, but only 29% (40 practices) plan to participate.
• 31% of respondents that plan to participate say that doing so will position them for success in other value-based models and “gives them a seat at the CMMI table.” Although EOM is not a mandatory model, many oncology leaders believe future Medicare value-based payment models will be.
• Practices that do not plan to pursue the EOM and those that do agree that phasing in 2-sided risk or making it optional would be beneficial.
• Practices not planning to take part in the EOM also recommended that CMMI increase monthly payments for required services. One practice wrote that the minimum should be $150, although some analyses have suggested that Medicare’s “loss” in the OCM was due to the size of the monthly payments combined with the level of shared savings once practices became more adept at operating the model.

COA leaders emphasized that the survey results do not mean community practices lack commitment to value-based payment models.

“Value-based care is the future of health care, and community oncology practices are eager to bring the latest and greatest care to their patients,” Judith Alberto, MHA, RPh, BCOP, COA director of clinical initiatives, said in a statement. “However, practices cannot do this when the barrier to entry and cost of participation potentially endangers the quality of care they provide, as well as the future stability of the practice.”

“The COA survey should serve as a red alert to CMS and CMMI that the success of the EOM is at risk,” Shiela Plasencia, COA director of practice support, said in the statement. “While it is good that some practices are predicting success in the EOM, that is far from certain. Unfortunately, the downside risk to practices, should this model go wrong, is far too great. CMMI must address the concerns of the majority of practices to ensure widespread success.”

Support for the EOM survey was provided by Janssen Oncology.