About 70 percent of practices participating in CMS' Oncology Care Model would owe payments if they entered the program's original two-sided risk arrangement — an option underperforming practices may face if they want to continue the program, according to healthcare consulting firm Avalere.
CMS' oncology model launched in 2016 as a five-year, voluntary bundled payment program that incentivizes practices to provide better care at a lower cost by achieving episode-based cost performance and quality measures. While all practices in the program are enrolled in a one-sided risk arrangement — under which a practice will share any savings from hitting those metrics — that will change in July.
At that time, CMS plans to require practices that haven't achieved a performance-based payment in their first four performance periods to enter a two-sided risk program or exit the model. Under a two-sided risk program, practices share in any savings, but also any losses. The two-sided risk model can either be the original program or a new iteration proposed by CMS — but about half of participants who enter the new program could still face recoupments.
"Many practices that could be required to switch to two-sided risk will likely face recoupment payments to CMS in future performance periods," Biruk Bekele, consultant at Avalere, said in the brief. "The decision to drop out of the OCM or switch to the new track will be decided on a practice-by-practice basis and will depend on many factors."