Becker's Hospital Review

15 CFO / FINANCE CMS to launch new oncology payment model under Medicare By Jakob Emerson T he Biden administration will launch the next phase of its Cancer Moonshot initiative next July with a new value-based oncology payment model through Medicare that aims to improve cancer care outcomes and lower costs nationwide. CMS will run the Enhancing Oncology Model from July 2023 to June 2028 and will study how to improve providers' ability to deliver whole-person cancer care. Participants in the voluntary model will in- clude oncology providers that treat Medicare patients undergoing che- motherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer and small intestine/colorectal cancer, according to a June 27 news release. Oncology physician group practices, commercial payers, Medicare Ad- vantage plans and state Medicaid programs located anywhere in the U.S. are encouraged to apply through Sept. 30. Oncology practices that participate in the EOM can expect to provide 24/7 access to a clinician, patient navigation services, a detailed care plan and screenings for health-related social needs. ey must use ev- idence-based guidelines, electronic patient-reported outcomes, data for quality improvement and certified EHR technology. Patients will be able to share feedback on their experience and health outcomes and will face no cost-sharing for the services. Beyond the monthly payment for providing the enhanced services, par- ticipants can also earn a retrospective payment for performance based on care quality and savings. CMS can also recoup payments based on performance, and participants will have to take on downside risk from the start. To improve health equity, the new model will include an additional pay- ment for participating providers that offer the new services to patients who qualify for both Medicare and Medicaid. Providers will be required to report patient demographic data and develop a plan showing how they will address health equity gaps among their patients. n Hospitals' spring revenue boost not enough to offset expenses By Andrew Cass H ospitals and health systems were hindered by skyrocketing expenses and depressed margins in May despite improved revenue and patient vol- ume, according to a June 28 Kaufman Hall report. The median change in operating margin was up 18.9 per- cent in May over April, but down 45.6 percent from May 2021, according to the report. Gross operating revenue was up 3.4 percent from April and 7.6 percent from May 2021. The report attributed revenue increases to a rise in patient volume in May. The length of stay was up 2.3 percent from April and patient days increased by 4.8 percent. Emergency department visits increased 9.5 percent from April to May. Total expenses rose 1.1 percent from April and 10.7 percent from May 2021, according to the report. Inflation and labor costs shortages have contributed to total costs climbing 10.4 percent year-to-date. "While we are seeing hospitals revenues inch up, it simply is not enough to mitigate the skyrocketing costs of material and labor expenses, resulting in negative operating margins for the nation's hospitals and health systems," Erik Swanson, senior vice president of data and analytics at Kaufman Hall said. "Hospitals are seeing labor costs increase at every lev- el as they compete with other hospitals and local employers to retain and attract non-clinical staff with higher wages and better benefits." n Care New England to remain independent By Andrew Cass P rovidence, R.I.-based Care New England's leaders say they have crafted a plan to allow the health sys- tem to remain independent rather than merge with a larger system, CBS affiliate WPRI reported July 6. The health system has faced financial challenges for years, which led to a series of unsuccessful merger attempts, ac- cording to the report. Most recently, regulators blocked a deal with Providence-based Lifespan. Care New England owns Women & Infants, Kent and But- ler hospitals and is Rhode Island's second largest health system. Care New England President and CEO James Fanale, MD, told WPRI the key to the plan is support from legislative leaders in the recently passed state budget. It includes a significant increase in the Medicaid reimbursement rate for delivering children. That part of the state budget is a boost to Women & Infants, where the majority of children in the state are born. The health system also is working on new agreements with business partners including Brown University, Blue Cross & Blue Shield of Rhode Island and Lifespan to ensure an operating margin that will allow for financial stability, ac- cording to the report. n

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