The Polite Bubble and Harold Miller of the University of Chicago criticized the CMO`s lack of response to the model. [4] In its view, the failure to eliminate FFS together is a primary flaw in the payment model. A superficial monthly payment does little to prevent unnecessary hospital visits that doctors must plan to justify actual care costs: announced by the CMS in January 2015, OCM is one of the newest programs in a litany of new experiences. Hospitals and other health care providers participating in one of these programs will find it difficult to effectively evaluate and manage their activities in order to improve the efficiency and efficiency of care and improve the patient experience. These providers must verify and monitor their data to determine opportunities for success in bundled payment programs and to measure the value of participation. The program is a step in the CMS to shift its focus to specialized care. [2]:372 Group design has been the source of praise and criticism for the payment system. The program was criticized because it did not go far enough; FFS is not completely eliminated. Other criticisms include the lack of flexibility in allowing primary care physicians to provide care as they see fit, the arbitrariness of the period or episode, the burden on reporting standards, and the way they disadvantage practices to achieve results that are prioritized. A related program is the Community Oncology Medical Home or COME HOME – a medical home development program at several oncology centers in the United States.
[13] OCM was based on this earlier model, developed by Barbara McAneny and Innovative Oncology Business Solutions through a $20 million CMMI grant. [5] COME HOME contained provisions that should be imitated later by OCM, for example.B.: Requirement for the use of electronic medical records (EHR), patient education, access to 24/7 telephone assistance and same-day appointments. The program reported lower rates of hospitalizations, use of emergency services and reduced costs for care. [2]373 For example, as oncology moves towards more oral chemotherapy, it may be more effective for practice and less tedious for the patient to have more frequent telephone and electronic recordings rather than having personal visits. In an FFS-based system, this means a considerable loss of revenue. [4]:117 The use of data for continuous quality improvement is one of the most important requirements for CMO participants. CMS and all participants have access to CMO data, both at the patient level and at the requirements level. The ability to understand and impact on the care components of oncology episodes will be critical to improving the situation, as practices must operate at certain levels to qualify for defined benefit payments.
In addition, firms must be higher than national benchmarks by the end of the third year or are excluded from further participation in the program. The results confirm the need for comprehensive risk adaptation, as there are many factors that affect care patterns and costs during a 6-month episode – the most important, cancer and comorbid chronic diseases. On the other hand, firms will gain experience in risk management, have the opportunity to influence future Medicare oncology programs, and have access to performance data that will allow them to measure past performance and identify areas for improvement.
