The Enhancing Oncology Model, or EOM, was created by CMS and CMMI as the replacement for the Oncology Care Model. To help you prepare for this new model before it begins on July 1, 2023, we’ve answered five of the most important questions about EOM.
What exactly is EOM?
EOM is a payment model made up of nine performance periods over the course of five years, with each episode lasting six months. The purpose of the model is to provide oncology patients with more equitable, value-based care as well as to improve health outcomes and engagement and increase savings.
What do I need to do as part of EOM?
If you have decided to participate in EOM, you will need to carry out several redesign activities. These include:
Providing patients with 24/7 access to care
Screening them for health-related social needs
Using electronic Patient Reported Outcomes and certified electronic health records
Giving detailed care plans and care navigation services.
And in return, you will receive semiannual reports detailing your performance, patient experience survey results and monthly claims data. We recommend using a digital platform to keep your team aware of all these changes.
EOM has two new requirements that OCM did not have. The first is that you must use health-related social needs screening tools to determine when patients have social determinants of health. The second is that you need to add an electronic patient-reported outcomes tool and implement it between the third and fifth years of the model.
Another major change is that EOM is only considering seven types of cancer: breast cancer, lung cancer, prostate cancer, chronic leukemia, small intestine/colorectal cancer, multiple myeloma and lymphoma. This is one of the reasons it will be challenging to earn payments under EOM.
How do I earn payments under EOM?
As an EOM participant, you will receive a performance-based payment for performing redesign activities. And you can earn a bonus, up to 4%, if you spend less than the targeted amount on care. But if you spend more than the recoupment threshold, you must make a payment to CMS.
The risk is higher than it was for OCM, and the reward has decreased as well. In OCM, the MEOS payment was $160 per beneficiary, or patient, per month, while it’s only $70 for the majority of beneficiaries in EOM. And, as previously mentioned, these payments are only for seven cancer types, compared to all cancer types in OCM.
However, you can earn an additional $30 per dually eligible patient.
What if I’m not participating in EOM?
If you are not participating in EOM, there are alternatives available. The Medicare Program, for instance, has Remote Patient Monitoring, Chronic Care Management, Principal Care Management and Complex Chronic Care Management billing codes that you can earn reimbursements for.
To learn more about EOM, check out our interview with Dr. Kashyap Patel, CEO, Carolina Blood and Cancer Care Associates.