Impact of Oncology Care Model (OCM) on episode costs and performance revenues: Considerations for oncology practices.

102Background: The OCM is focused on providing high-quality, cost-efficient oncology care in Medicare. The episode payment approach introduces performance-based payments (PBPs) alongside traditional fee-for-service reimbursements. There is not yet a clear picture of the impact of the OCMs implementation on oncology practices. Methods: Using the Medicare Standard Analytic Files (5% sample) Part A and B claims, this study replicates the OCM benchmarking payment methodology. OCM episodes were triggered by qualifying Part B cancer therapies administered in an outpatient setting; all Part A and B costs that occurred in the following 6-months were included in episode costs. Claims for the baseline period (July 2012 – June 2015) were used to calculate actual episode costs, and predicted episode costs were used for benchmarks. Claims were also used to estimate OCM claims-based quality measure scores. Quality measure scores determined a practice’s performance multiplier, which is part of the PBP calculation. Resul...