In Reply We agree with Dr Ennis that the findings of our study¹ of the OCM through 3 years were disappointing. The savings of $503 per episode in higher-risk episodes were insufficient to offset the enhanced oncology services payments of $160 per patient per month, which averaged $760 per episode across all episodes. Moreover, despite the OCM requirements that sought to improve quality of care and patient engagement, we did not observe meaningful changes to measures of quality or outcomes, nor did we observe improvements in patients鈥� experiences of care.

As Ennis points out, practices could elect 1-sided or 2-sided risk arrangements, and all practices opted for 1-sided risk through the first 30 months of the model. After this period, practices that had not received at least 1 performance-based payment were required to engage in 2-sided risk if they chose to continue in the model. We agree with Ennis that requiring practices to have more 鈥渟kin in the game鈥� may have increased the likelihood of OCM-related savings. However, if the OCM had required 2-sided risk at its start, it is possible that practices may have had limited enthusiasm to participate in this voluntary model. Mandatory models are another potential strategy for engaging practices; however, such models have met substantial resistance from the physician community. An example is the proposed Radiation Oncology Model,² which has been delayed twice by Congress, most recently in December 2021.