SYRACUSE — The Centers for Medicare & Medicaid Services (CMS) has selected oncology physicians at the Upstate Cancer Center to participate in a care-delivery model that “supports and encourages higher quality, more coordinated cancer care.” Upstate is one of nearly 200 physician-group practices and 17 health-insurance companies that CMS chose for the initiative, Upstate said […]
SYRACUSE — The Centers for Medicare & Medicaid Services (CMS) has selected oncology physicians at the Upstate Cancer Center to participate in a care-delivery model that “supports and encourages higher quality, more coordinated cancer care.”
Upstate is one of nearly 200 physician-group practices and 17 health-insurance companies that CMS chose for the initiative, Upstate said in a news release issued July 1.
The Medicare arm of the “oncology-care model” includes more than 3,200 oncologists and will cover about 155,000 Medicare beneficiaries nationwide.
“We are pleased to be selected for this important transformation project, and welcome the opportunity to further embrace Upstate Cancer Center’s commitment to quality care and practice efficiency that help strengthen and enhance the care patients receive,” Richard Kilburg, administrator for the Upstate Cancer Center, said in the Upstate release.
The Upstate Cancer Center, which opened in the summer of 2014, provides much of Upstate’s ambulatory cancer care.
“The oncology-care model encourages greater collaboration, information sharing, and care coordination, so that patients get the care they need, when they need it,” Health and Human Services Secretary Sylvia Burwell said in the news release. “This patient-centered care model fits within the administration’s dual missions for delivery-system reform and the White House Cancer Moonshot Task Force to improve patient access to and the quality of health care while spending dollars more wisely.”
About the model
Practices participating in the five-year, oncology-care model will provide treatment following “nationally recognized” clinical guidelines for beneficiaries undergoing chemotherapy, with an emphasis on person-centered care.
They will provide “enhanced” services to beneficiaries who are in the oncology-care model to help them receive “timely, coordinated” treatment.
The services may include coordinating appointments with providers within and outside the oncology practice to ensure “timely” delivery of diagnostic and treatment services.
They may also include providing round-the-clock access to care when needed.
In addition, the services could include arranging for diagnostic scans and follow-up with other members of the medical team such as surgeons, radiation oncologists, and other specialists that support the beneficiary through their cancer treatment.
The practices will work to make sure that data from scans, blood-test results, and other tests are received in advance of patient appointments so that patients do not need to schedule additional visits.
Their services could include providing access to additional patient resources such as emotional-support groups, pain-management services, and clinical trials.
The oncology-care model encourages practices to “improve care and lower costs” through episode- and performance-based payments that reward “high-quality” patient care, Upstate said.
It is one of the first CMS, physician-led, specialty-care models and “builds on lessons learned” from other programs and private-sector models, according to the release.
As part of this model, physician practices may receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, along with a monthly care-management payment for each beneficiary.
The two-sided, risk track of this model would be an advanced alternative-payment model under the newly proposed, quality-payment program, which would implement provisions from the Medicare Access and CHIP Reauthorization Act of 2015, according to the Upstate news release.
Contact Reinhardt at ereinhardt@cnybj.com