Timeline Is Extended for Practices Struggling With COVID-19

June 4, 2020
Tony Hagen

Tony Hagen is senior managing editor for The Center for Biosimilars®.

Recognizing that oncology practices are struggling with the pandemic, the Center for Medicare and Medicaid Innovation has eased some performance requirements.

The Oncology Care Model (OCM) has served as a proving ground for the value of biosimilars, as various studies presented at this year’s American Society of Clinical Oncology meeting show.

The model of value-based care established through CMS’ Center for Medicare and Medicaid Innovation (CMMI) was intended to terminate next year and be replaced. It’s now among a number of models that CMS has decided to extend owing to the disruption caused by the coronavirus disease 2019 (COVID-19) pandemic. The OCM will now extend 1 additional year, until mid-2022.

A key feature of the model was that practices would share the upside financial gain that CMS received from savings achieved by the model. Eventually, they also would have to share the financial downside (ie, negative savings) as they learned how to manage the model's complex requirements.

As part of the COVID-19 arrangements, the 175 practices enrolled in the model will have the option to forgo the upside and downside risks associated with performance reporting periods during the pandemic. Practices have seen reduced flow of patients, and the practice of oncology has been made more complicated by the need to ensure the safety of clinicians and patients. Clinical trial activities also have been disrupted.

As one of the concessions offered by CMS for practices that choose not to forgo the upside or downside risk, episodes of care affected by COVID-19 will not be factored into their performance evaluations.

“When it comes to a pandemic of the proportion we’re now experiencing, as part of ensuring that value-based payments are sustainable, the models must be adjustable to address the uniqueness of the current situation,” CMS Administrator Seema Verma said in a blog post in Health Affairs.

For more about the CMMI decision, read the full story at AJMC.com.