Measuring Quality and Value in Oncology

The Need for Measurement Payers (Medicare and private insurers) are demanding quality, cost control, accountability, and predictability – Measuring quality and value in cancer care now enabled by IT The cost of treating cancer is increasing – Payment of cancer care is at a crossroads – Cancer patients under active therapy represent 1% of patients but 10% of payer’s costs

The Need for Measurement  Little effort to measure health care quality until just a few decades ago  Most aspects were considered unmeasurable  I don’t judge my colleagues quality of care through formal measurement  That may work for me, but what about everyone else?

The Need for Measurement  Additional research revealed wide variability in the safety and quality of health care  Success in measuring hospital readmission rates  National readmission rates declined from 19% to 17.5%  Not all measurements produce good behaviors  CMS hospital quality measure: first dose of antibiotic given within 6 hours after presentation  Led to inappropriate antibiotic use in patients without pneumonia

Federal Initiatives  Physician Quality Reporting System (PQRS)  Meaningful Use of Electronic Health Records

Federal Initiatives

The McNamara Fallacy  Just because you can measure it, doesn’t mean it is relevant, important, or informative

The COA OMH Game Plan  Create general consensus and unity among stakeholders Patients Payers Providers  Agree on quality and value Measures – With benchmarking – Patient satisfaction – With benchmarking  Create a template for viable payment Private payers Medicare  Help practices implement Process change Payer contracting Accreditation IT Solutions

Model Identify Stakeholder Needs Define Model Elements Develop Certification/Recog nition MeasurementImplementation I dentify Vendors Categorize Tools Develop Practice Implementation Guide Payment Identify Viable Payment Models Develop Private Payer Templates Develop Medicare Model Develop Quality/Value Measures Develop Patient Satisfaction Tool Develop Quality/Value Measures Develop Patient Satisfaction Tool Oncology Medical Home Oncology Medical Home Summary

IT Advisory Team Representation Industry RepresentationPractice Representation AltosFlorida COAGeorgia CoCOhio COME HOMETexas Elekta FlatIron iKnowMed Net.Orange Unlimited Systems Varian

Oncology Medical Home

Cancer Care Satisfaction Survey:  Developed by oncology stakeholders for oncology stakeholders  Using guidance and resources from:  ALL resources are FREE to ALL providers of cancer care Practices must register on the OMH web site for benchmarking:

Cancer Care Satisfaction Survey:  Current usage:  Over 36,000 surveys  1,165 registered providers  Our practice, surveys performed twice  Update is being planned  Aligns with upcoming changes to CAHPS core questions  Will allow comparisons to other specialties  Target date - May 4 th, 2015

14 Benchmarking/Survey Reports

Example: Summary Scoring

Patient Satisfaction Surveys Question Median Result In the last 12 months, how many days did you usually have to wait for an appointment when you needed care right away? Same day50% 1 day23.6% 2 to 3 days16.5% 4 to 7 days5.7% More than 7 days 2.7% In the last 12 months, when you phoned this provider’s office during regular business hours, how often did you get an answer to your medical question that same day? Median Result Always71.4% Usually21.0% Sometimes5.9% Never1.6%

Patient Satisfaction Surveys In the last 12 months, did you feel that this provider always told you the truth about your health, even if there was bad news? Median Result Yes, definitely92.7% Yes, somewhat6.4% No0.7% In the last 12 months, how often did this provider spend enough time with you? Median Result Always80.5% Usually16.4% Sometimes2.1% Never0.4% In the last 12 months, did your primary care physician or other specialist team seem informed and up-to-date about the care you received from your hematology/oncology provider? Median Result Always61.8% Usually23.4% Sometimes7.9% Never4.0%