ASCO’s Patient-Centered Oncology Payment Program

ASCO’s Patient-Centered Oncology Payment Program

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed how oncologists will be paid for their services, from a fee-for-service to a value-based approach. It replaced the sustainable growth rate formula with two new payment systems that emphasize quality over quantity of cancer care: the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). ASCO’s Patient-Centered Oncology Payment (PCOP) program was created as an APM.

Dr. Stephen S. Grubbs
Developed by oncologists from different practice settings, PCOP supports high-value, high-quality cancer care, while holding oncologists accountable for aspects of their practice that they can improve. It offers oncologists three options to transition into an APM at their own pace and even assists practices in modeling data and implementing tools to help them determine which areas they need to focus on to be successful under an APM.

The modeling that created PCOP estimated that practices that successfully deployed the APM would reduce drug spending by 7% and emergency room visits and hospitalization by 30%, leading to an overall reduction of the cost of care of 8.2% for an episode of chemotherapy. The savings would be distributed to the practice with a 50% increase in service revenue, and the payer would have an overall reduction in the cost of care by 3.9%.1

“The PCOP model offers medical oncologists and interested payers the opportunity and framework to collaborate in an oncology-based alternative payment model,” Stephen S. Grubbs, MD, ASCO’s vice president of Clinical Affairs, said.

The overarching COME HOME program and its tools, through a Center for Medicare and Medicaid Innovation grant, have demonstrated improved health care utilization and costs while maintaining patient satisfaction. Early results show a reduction of emergency room visits by 11.7%, hospital admissions by 6.7%, and 30-day hospital readmissions by 12.5% while achieving a 98.1% patient satisfaction.2

As an expansion of the COME HOME program made in conjunction with ASCO and Innovative Oncology Business Solutions, Inc., ASCO COME HOME can help with the transition to PCOP. Made available in February, the program provides practices with an assessment of whether or not they are ready to transition to PCOP and tools to help them make the change.

“The ASCO COME HOME program provides guidance and tools for practice transformation required for success in the new era of value-based payments,” Dr. Grubbs said.   

–Danielle Prieur