The Enhancing Oncology Model, or EOM, starts July 1, 2023. Here’s what you need to know to get paid under EOM.
Video Transcript
You’ll need to perform redesign activities as part of EOM. Screening patients for health-related social needs counts toward redesign activities. So does providing detailed care plans and care navigation services.
These redesign activities earn you a performance-based payment. The MEOS payment is $70 per patient per month, for the majority of beneficiaries. This is less than the $160 in the previous model: OCM.
You can also earn a bonus, up to 4%, if you spend less than the targeted amount on care. If you spend more than the recoupment threshold, you must make a payment to CMS.
Good news: you can earn an additional $30 for dually eligible patients on Medicare and Medicaid.
Another major change from OCM is that EOM covers only seven cancer types: breast cancer, prostate cancer, lung cancer, chronic leukemia, small intestine/colorectal cancer, multiple myeloma and lymphoma.
Patients who have breast or prostate cancer but only receive hormonal therapy are exempt from EOM.
Note that breast, lung, colorectal and prostate cancer did make the list of top 10 most common new cancer cases in 2020, with breast cancer accounting for 12.5% of all cancers and lung cancer accounting for 12.2%.
EOM has the potential to be a rewarding model for your practice, especially if you have a significant amount of dually eligible patients and your practice has already implemented processes to deliver and track quality care. If this isn’t the case or you don’t have the resources needed for redesign activities, EOM may not be a successful payment model for your practice.
For more information about EOM and what it means for you, check out the blogs and articles on our PatientPoint website.