RevCycle Intelligence March 16, 2021
Lack of clinical data analysis in the development of CMS’ metastatic risk adjuster may lead to skewed bundle payments for oncological care.
Incorporating clinical data into risk stratification could improve the accuracy of CMS bundled payment models like the Oncology Care Model (OCM), according to a new Avalere analysis.
The OCM is a bundled payment model that evaluates the total cost of care for episodes initiated by chemotherapy treatments within six-month performance periods (PP). At the end of each period, CMS measures practice performance by comparing total expenditures to a benchmark price predicted by factors like tumor type, comorbidities, member demographics, and utilization of certain services.
Participating practices that stay within the benchmark price earn a performance-based payment (PBP) and...
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