Don’t Throw Away Community Oncology’s Hard Work: Extend the Oncology Care Model

J Clin Pathways. 2021;7(10):26.

The start of the new year is the functional end for the Oncology Care Model (OCM), a multimillion dollar, years-long program that has helped community oncology practices large and small transform the way they provide care to patients with cancer. What is next for practices seeking continual improvement? We do not know.

The Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI) have not developed a successor program to the OCM or indicated how practices should maintain the improved levels of care developed under the program. Advocates across the country have asked for updates from the agencies only to be met with silence. For now, practices are working without a roadmap.

On November 15, 2021, the Community Oncology Alliance (COA) submitted formal comments to Chiquita Brooks-LaSure, administrator of CMS, and Elizabeth Fowler, PhD, JD, deputy administrator and director of CMMI, asking to immediately extend the OCM past the scheduled termination date of June 30, 2022, until at least December 31, 2022.¹ Although the model does not end until the middle of next year, it is functionally over on January 1 when no additional patients can be enrolled. When the model officially ends, practices will be forced to abandon the gains they have made under the OCM, wasting millions of taxpayer dollars and reversing progress made in cancer care.

Previously, practices anticipated a transition into the successor model to the OCM, the Oncology Care First (OCF) model. However, advocates and practices have not seen or heard developments on the OCF, and the predominate rumor is that CMMI will not pursue the OCF at all. CMMI cannot shirk its duty to foster innovation in health care and offer no new models.

CMMI’s reasoning for the cancellation of the OCM is that the model has been a failure according to their own measurements. The agency has expressed dissatisfaction with participant performance during the five performance periods of the OCM’s existence. It is crucial that the model and measurement continue because the OCM is the most radical transformation of cancer care ever seen in the United States. Many practices required a dramatic retooling of finances, resources, staffing, etc, to even take part in the program. It takes time to absorb the financial impact of such a shift.

The COVID-19 pandemic also played a large role in skewing the numbers. Finding success in a payment reform model during a pandemic should be close to impossible, but many community oncology practices shouldered the burden of patient safety and still managed to thrive under the OCM. From a measurement perspective, it makes more sense to adopt a “wait and see” approach regarding performance as the pandemic winds down rather than stopping the OCM prematurely.

Outside analysis of OCM performance tells a different story than the CMMI narrative. The OCM is the starting point for at least 35 oncology payment reform models in the country, and others are being developed using the OCM as a base. An analysis of OCM performance conducted by Avalere Health found that community oncology practices were well-represented among the “high-performing” category, comprising almost half of the practices measured. Additionally, many participants are finding success implementing biosimilars to reduce costs and maintain high-quality, cutting-edge care.

COA President Kashyap Patel, MD, and his practice found great success in the OCM. Dr. Patel runs a small practice located in South Carolina which excelled in many of CMMI’s metrics, including reduced cost of patient hospitalizations and emergency room visits, lower Medicare expenditures per beneficiary per month, increased use of biosimilars, and more. Success has not been limited to smaller practices; larger practices, like Florida Cancer Specialists, are reporting lower hospital utilization and treatment costs. Against all odds, community oncology has persevered through a public health emergency to completely transform the way they offer care.

We cannot afford to move backward in cancer care. The new standards in cost, quality, and innovation established by the OCM should be the basis of the next generation of research and development. As health care returns to normal, it is imperative that CMS and CMMI have a plan for ensuring innovation remains a top priority. The first step is extending the OCM. 

1. Patel K, Okon T. COA Letter to CMS and CMMI Requesting Extension of OCM. Community Oncology Alliance. November 15, 2021. Accessed November 16, 2021. https://communityoncology.org/coa-letter-to-cms-and-cmmi-requesting-extension-of-ocm/