- Although MACRA launched the Quality Payment Program on Jan. 1, 2017, a recent American Society of Clinical Oncology (ASCO) report stated that many oncology practices still need to expand or improve services and data reporting to meet the program’s performance standards.
While most oncologists participated in at least one quality reporting program and were meaningful EHR users, the report in the Journal of Oncology Practice found that oncologists may face several obstacles with participating in the Quality Payment Program, especially it’s Merit-Based Incentive Payment System (MIPS).
Many oncologists felt unprepared for reporting and do not feel confident about earning a positive MIPS payment adjustment based on 2017 performance.
The ASCO’s findings echoed the results of a recent Stoltenberg Consulting survey that found 64 percent of healthcare providers were either unprepared or very unprepared for MACRA implementation in February 2017. The participants also pointed to insufficient data reporting mechanisms as their chief obstacle.
In addition to data reporting concerns, ASCO identified the truncated MACRA implementation timeline as a potential challenge for oncologists. The Quality Payment Program started just a couple months after CMS released the final MACRA implementation rule in November 2016.
CMS did not leave enough time for providers to digest the new Medicare value-based reimbursement initiative and prepare their practices. Other healthcare stakeholders, including industry groups and vendors who aid practice transformations, also have not had enough time to analyze the rule and provide guidance to clinicians.
As a result, the oncology workforce is not fully aware of MACRA implementation requirements, ASCO continued. The industry group cited a 2016 Deloitte survey of over 500 physicians that revealed one-half had never heard of MACRA and another 32 percent were familiar with the law’s name but not with the requirements.
Another MACRA implementation challenge for oncologists may be the increased financial risk under the Quality Payment Program, ASCO reported.
“Physicians will face a period of financial risk and uncertainty as MACRA rules are implemented,” the industry group wrote. “The full financial implications of MACRA will not become apparent for several years after the full set of incentives and penalties are implemented.”
Additionally, ASCO identified the lack of oncology-specific alternative payment model (APM) options as a major MACRA implementation hurdle for oncologists.
Under the Quality Payment Program, eligible clinicians have several options for participation, including MIPS and an Advanced APM. The Advanced APM track offers eligible clinicians the greatest financial reward, but only Medicare’s Oncology Care bundled payment program is an approved model.
“Because OCM [Oncology Care Model] is available only to a limited number of oncology practices, ASCO and others in the oncology community have asserted that multiple oncology APMs will be needed to address the wide variety of practices and the complexities of cancer care,” the report stated. “Currently, these models do not exist or are not ready for implementation.”
Harvey L. Neiman Health Policy Institute researchers expressed similar concerns about Advanced APM options for radiologists. Given the role of radiology in diagnostic care, researchers were surprised that most Advanced APMs focused on primary care providers rather than radiologists or even other specialists.
While specialist groups across the healthcare industry are pushing for more Advanced APMs, ASCO noted that developing oncology-specific APMs may be especially challenging for stakeholders. Oncology-specific value frameworks exist, but stakeholders tend to have trouble defining value, gathering comprehensive data, and incorporating patient-centered care.
First, stakeholders must overcome the value definition challenge. “The goal of oncology-focused value initiatives should be to achieve high-value care for patients with cancer,” the report stated. “However, defining value in cancer care is difficult and the components of value itself may differ among health systems, payers, patients, oncologists, and manufacturer.”
ASCO suggested that stakeholders focus on developing different oncology-specific value frameworks that focus on different stakeholder needs. For example, some models should hone in on cost-effectiveness, while other models should center on patient-provider dialogue.
Second, the report explored how oncology-specific value frameworks tend to depend too much on clinical trial data.
“Calculations of benefit and toxicity are key components of all cancer-focused value initiatives,” the oncology group wrote. “These measures typically are drawn from randomized controlled trials (RCTs), which are considered the gold standard of clinical research.”
“However, RCTs have been criticized for not allowing cross comparisons of multiple drugs or treatment regimens, for excluding large groups of patients who do not meet strict eligibility criteria, and for failing to incorporate qualitative measures of interest to patients who are weighing different treatment options.”
Future value frameworks should integrate clinical and financial data analyses to ensure the APMS cover all patients across different price points.
Finally, many oncology-specific APMs do not use patient perspectives on value-based care and reimbursement like other models.
“Patient groups also complain that they have been excluded from the process of developing frameworks, even those intended for patient use,” the industry group elaborated. “Clearly, to make oncology value frameworks more patient-centered, a need exists to incorporate the patient’s voice going forward.”
To transition oncologists and cancer care delivery to more value-based reimbursement models, such as MACRA, ASCO suggested that CMS offer more opportunities for providers and patients to provide feedback on MACRA. The federal agency should particularly support more oncology-specific APMs for MACRA.
The oncology community and healthcare stakeholders should also continue developing oncology value frameworks and APMs to push cancer care to value-based reimbursement.
“ASCO urges the oncology community and other stakeholders to continue to refine and improve methods for assessing the comparative value of treatment options for patients with cancer and to use these assessments to support decision making among clinicians, patients, payers, and other stakeholders,” the group concluded.