CMS’ oncology alternative payment model reduced utilization of imaging services in Medicare

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The Centers for Medicare & Medicaid Services’ oncology alternative payment model produced lower utilization of imaging services, according to new research published Tuesday in JAMA.

CMS introduced the five-year, value-based care effort in 2016 aiming to control cancer treatment costs, which reached $200 billion last year. Under the Oncology Care Model, about 200 physician practices inked agreements to bolster coordination and reduce unplanned care for patients receiving chemotherapy.

Researchers sought to analyze the model’s impact on healthcare spending, utilization and quality during the first three years. They found the model was significantly associated with modest decreases, including about 46 fewer imaging services used per 1,000 care episodes.

All told, the Oncology Care Model produced a $297 per-episode decrease in Medicare episode payments (about $18 fewer on imaging), which was insufficient to offset CMS’ investment in the effort.

“The OCM was not associated with a decline in any critical quality measures, and this negative result is noteworthy,” Raymond Osarogiagbon, MBBS, with Baptist Memorial Health Care Corp. in Memphis, Tennessee, and colleagues wrote in a corresponding editorial. “One of the chief concerns of value-based payment models is the theoretical risk that financial incentives will induce restrictions in essential care. The OCM had no demonstrable adverse effects on care quality and in that important respect represents a positive outcome.”