A New Tool for Providers to Help Cancer Patients Understand and Prepare for Treatment Costs

The Oncology Care Model Beneficiary Liability Tool helps Medicare beneficiaries better plan for treatment

Cancer is a devastating—yet all-too-common—diagnosis in the United States. Apart from uncertainty around treatment and outcomes, patients must also deal with the uncertainty of the financial burden treatment may pose—”What is my treatment going to cost, and how can I pay for it?”

To participate in the Centers for Medicare & Medicaid Services (CMS) Oncology Care Model (OCM), providers are required discuss with their Medicare beneficiaries their estimated treatment costs, including what will be covered by Medicare and what will not. Although this information is very important for patients, chemotherapy providers are unable to provide beneficiaries with estimates of their liability for radiation therapy, surgery, or other treatments.

To meet this need, RTI’s Center for Health Care Advancement has developed a tool for CMS and for OCM providers that would help them estimate Medicare beneficiaries’ financial liability for their cancer treatment. The new OCM Beneficiary Liability Tool is an easy-to-use tool that helps medical oncologists providing chemotherapy estimate what Medicare will not cover for radiation therapy, imaging, and laboratory and other tests for their Medicare beneficiaries. The tool can be used in multiple settings, and other modules of the tool will provide estimates for beneficiary liability for cancer surgery in the coming months.

The OCM Beneficiary Liability Tool provides valuable assistance for oncologists, enabling them to help Medicare beneficiaries understand and plan for treatment costs that are not covered by Medicare. Beneficiaries may have supplemental insurance to cover these costs. Providing better estimates of out-of-pocket costs will allow providers to connect beneficiaries with additional resources to help them cover these costs, including local foundations and other social services. The tool is one way RTI’s Center for Health Care Advancement is helping payers and providers work together to improve patient outcomes in a responsible, cost-efficient way. Contact us to learn how we can help you use the tool in your organization to improve quality of care for your patients.