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The New Medicare Enhancing Oncology Model: Should Your Organization Participate?

Organization Participate

The Enhancing Oncology Model (EOM) is a new alternative payment model (APM) from Medicare that offers oncology practices the opportunity to improve care quality and reduce spending for their Medicare fee-for-service (FFS) patients. This five-year model builds on the successful Oncology Care Model (OCM) and provides additional incentives to address health disparities. Set to begin July 2023, potential participants must submit a nonbinding application by September 30, 2022, to secure their participation opportunity. So, if you are wondering if your organization should apply to participate in EOM, read on to learn more.

Is Your Organization Eligible to Participate in EOM?

To be eligible to participate in EOM, your organization must be an oncology physician group practices (PGPs) with a taxpayer identification number (TIN). Participation is available to PGPs with oncologists who bill for cancer-related evaluation and management services under a different PGP TIN. This flexibility was not provided under OCM. Additionally, hospitals and health systems can participate in EOM as Care Partners. However, oncology practices frequently recommend patients to Prospective Payment System-Exempt Cancer Hospitals are not eligible to participate.

If you think your organization meets the eligibility requirements, the next step is to submit a nonbinding application by September 30, 2022. Doing so will secure your opportunity to participate in EOM. For more information on the application process and oncology care model, visit the Centers for Medicare and Medicaid Services website.

The Benefits of Participating in EOM

There are many benefits associated with participating in EOM and various other care coordination. In this case, participants have the opportunity to improve care quality and reduce spending for their Medicare fee-for-service patients. In addition, if their program spending falls below a predetermined financial target, EOM participants may be eligible for Performance Based Payment (PBP). Further than the target amount, there is no minimum requirement that must be met in order to qualify for PBP. Based on quality performance, the final PBP and Performance Based Recoupment (PBR) will be adjusted.

EOM participants may also receive $70 Monthly Enhanced Oncology Services (MEOS) payments to provide enhanced services. They may also receive an additional $30 MEOS payment for dually eligible patients. While MEOS payments for dual beneficiaries are kept by the participant regardless of financial performance, MEOS payments for non-dually eligible beneficiaries will be recovered at reconciliation. Apart from this, there are various other benefits associated with participating in EOM, and can be found on the Centers for Medicare and Medicaid Services website.

The Bottom Line

With the help of this guide, you should now have a better understanding of the new Enhancing Oncology Model and whether or not your organization is eligible to participate. If you think your organization meets the requirements, be sure to submit a nonbinding application by September 30, 2022. Doing so will secure your opportunity to participate in EOM and take advantage of all the associated benefits.