Practice Matters

News from Lola Butcher about health policy and practice management issues of importance to oncologists

Tuesday, July 8, 2014

Oncology Medical Home? Tune in Tomorrow!

New Mexico Cancer Center (NMCC), one of the pioneers of the oncology medical home model, will be featured in a MEDTalk: Reinventing Patient-Centered Cancer Care webcast starting at 10:30 am ET on Wednesday.   


Everybody interested in the future of cancer care delivery and payment should be tracking what NMCC and the other practices in the COME HOME program are doing. The Centers for Medicare & Medicaid Innovation (CMMI) awarded Barbara McAneny, MD, NMCC CEO, a $20 million grant to test the oncology medical home model because CMS thinks that might be an alternative payment approach that makes cancer care financially sustainable.


Check out this Health Affairs blog post to get a sneak peek on how it’s going. Some of the top health care policy people in the U.S. -- Darshak Sanghavi, MD; Mark McClellan, MD; and Kavita Patel, MD -- all of Brookings Institution, write a brief case study that includes this troubling observation: “NMCC currently receives approximately $70,000 per month from the CMMI grant and has not yet identified a clear strategy to sustain the delivery reforms in the COME HOME care model past the end of the grant (July 2015). As for payment reform options, NMCC has been unable to contract as part of a comprehensive ACO due to local health care market conditions.”


But it also includes this fascinating observation:  “NMCC could potentially use the medical home approach with risk sharing (described above) as a first, interim step toward a bundled payment system, NMCC’s long-term preferred model.”


The “described above” is what you need to pay attention to. The blog post includes a table (see Table 2 about half-way down the post) that shows the level of financial risk to oncologists associated with four alternative cancer care payment approaches. Oncology medical home has minimal risk; bundled payments—identified as NMCC’s true goal—has high risk. That means NMCC is positioning itself to accept a flat rate—and guarantee certain quality standards—to treat a population of cancer patients.


If that is where cancer care is headed, will your practice be ready?