Medicare will test pay models for radiation oncology, dialysis

Beginning in 2021, Medicare will test alternative methods of paying for radiation oncology and dialysis, with the giant federal insurer saying it is seeking to improve the quality of care delivered and also save money.

The Centers for Medicare & Medicaid Services (CMS) today announced it had finalized a rule creating the two test programs. Both programs are set to start January 1. The kidney care model will run through June 30, 2027, with expected savings of $23 million, according to a CMS news release. The radiation oncology (RO) model will end December 31, 2025, with expected savings of $230 million, CMS said.

“We believe the models will further the agency’s goal of increasing the extent to which CMS initiatives pay for value and outcomes, rather than for volume of services alone,” the agency said in the rule.

The goal of the RO model is to let people on Medicare potentially undergo fewer treatments while getting better outcomes, CMS said. This model may “reduce travel time required for treatment, reduce side effects, lessen the time spent in a doctor’s office or waiting room, and free up time for patients to engage in other activities that can help improve their overall quality of life,” CMS said in a separate news release

CMS already is running a large test of payment for cancer treatment, known as the Oncology Care Model (OCM). As of January 2, 2020, 138 practices and 10 commercial insurers were participating in the OCM, according to the CMS webpage for that program.

Launched in 2016, the OCM is a 5-year program that requires practices to reduce the cost of care while improving quality and patient outcomes. If participating practices achieve OCM objectives and maintain quality while reducing the cost of care, CMS shares a portion of the savings.

In addition, practices also receive a monthly incentive payment for every patient that is enrolled in the program.

A study of the early OCM results, published May 18 in JAMA Network Open, indicated there has been less physician-administered drug use in prostate cancer, lower drug costs in lung and prostate cancer, fewer visits for patients with breast or colon cancer, and lower office-based costs in all cancers analyzed in the OCM. But these savings were largely offset by other costs. Medscape

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