The new Enhancing Oncology Model (EOM) from the Centers for Medicare & Medicaid Services (CMS) launches next summer, but leaders of many cancer practices are uncertain if they will participate. Oncologists from community practices discussed their reservations regarding the financial risks and data collection requirements associated with the EOM at the Community Oncology Alliance’s (COA) Payer Exchange Summit on Oct. 24 in Tyson’s Corner, Virginia.
CMS and the CMS Innovation Center (CMMI) will open the EOM, which replaces the Oncology Care Model, to practices on July 1, 2023. The deadline for practices to apply was Oct. 10, 2022.
Some of the concerns cited at the summit included the risk arrangement for participating practices, as well as the smaller number of patients being covered. The EOM has two risk arrangements, both of which have different levels of immediate downside risk where practices could lose revenue and have to pay CMS back. In addition, the model focuses only on patients receiving systemic chemotherapy for seven types of cancer: breast, chronic leukemia, small intestine/colorectal, lung, lymphoma, multiple myeloma, and prostate.
“The first glance at the EOM was, ‘Gosh, they’re asking us to do more for less and it’s going to be less of our patient population, so then it becomes a little bit more complicated,’” said Susan Escudier, MD, vice president of value-based care and quality programs at Texas Oncology in Houston.
Another challenge facing EOM participants will be a requirement to collect and report on data regarding social determinants of health (SDOH). Smaller practices may not have the staff to collect SDOH data.
“I think we all understand that social determinants of health are tremendous and have a huge importance on our patients’ outcomes and how we take care of these patients, but I’m not sure that my small, three-oncologist practice can solve homelessness,” Dr. Escudier said.
Earlier this month, COA sent a letter to CMS and CMMI commenting on the EOM, saying that several of its member practices have expressed concerns about sharing this type of patient data. Barbara McAneny, MD, chief executive officer of New Mexico Cancer Center in Albuquerque, whose practice serves members of multiple Native American tribes, said she worries that collecting this type of data could jeopardize years of trust she has built with a community that has been historically disenfranchised by the federal government.
“Therefore, am I willing to put that acceptance that is hard-fought on the line to collect data to give data to the federal government where nothing is going back to that population that will be of value to them? That is something that I’m really struggling with,” she said.
Many practices have had to go ahead and apply for the EOM given the Oct. 10 deadline. However, their actual participation still depends on answering these types of questions, as well as making financial projections for how participating in the EOM will impact them.
We’re far from accepting this model going into it. We applied for it. Many practices applied for it. At the last moment, we’ll decided whether we’re going to do it or not,” said Sibel Blau, MD, president and chief executive officer of the Quality Cancer Care Alliance and medical director at Northwest Medical Specialties, PLLC, in Tacoma, Washington.
Dr. Blau reported associated research funding from Merck Sharp & Dohme, Sanofi and Genzyme, and Genentech.
Dr. Escudier and Dr. McAneny reported no relevant relationships.