Benchmarking: If You Can’t Measure It, You Can’t Manage It. Teri U. Guidi, MBA, FAAMA President and Chief Executive Officer Oncology Management Consulting Group Elaine L. Towle, CMPE Director, Consulting Services Oncology Metrics®, a division of Flatiron Health, Inc. Agenda • 2014 National Hospital Oncology Benchmark Study • National Practice Benchmark, 2014 Report on 2013 Data National Hospital Oncology Benchmark Study • In 2013, and in response to the recurring requests on list serves, from colleagues and from clients, OMC Group solicited volunteers to contribute data for a pilot analysis of productivity in hospital-based infusion and radiation centers. • It was a big hit! • In 2014, we expanded the number of centers and the number of data points. 4 2014 Infusion Data Points • • • • • • • • Calendar year 2013 data Patients per FTE Encounters per FTE and patient Chairs per FTE Active treatment hours per FTE and patient Drug doses mixed per pharmacy staff Registry cases per registrar FTE categories include: nutritionist, financial counselor, social worker, NPP, LPN/NA, MA, RN, patient navigator, pharmacist, pharmacy tech, hemeonc. 2014 Infusion Data Slices • Size of infusion center • Academic or Community • Major disease sites – – – – – – Breast Colorectal Lung Prostate Benign Hematology Non-oncology 2014 Data • 45 infusion centers • 27 radiation departments • All billed services for any patient that had activity in the infusion department • Unique patient id • Date of service and diagnosis • CPT/HCPCS code and billed units • Tumor registry report • Program data – Hours of operation – Budgeted FTE’s – Equipment (chairs, linacs, etc.) – Physicians 7 Caveats • All centers are coding and billing services correctly • All centers code chief complaint in one of the first 3 ICD-9 positions • All centers interpreted survey questions consistently • Some patients may be counted more than once in disease-specific data (different diagnosis at different encounters) 8 Infusion Center Profiles HID H66 H45 H47 H65 H55 H48 H56 H54 H53 H41 H42 H08 H68 H36 H57 SMALL CENTERS ACADEMIC/ INFUSION UNIQUE COMMUNITY ENCOUNTERS PTS C 2 7 C 13 10 C 244 72 C 310 102 C 393 116 C 400 88 C 441 141 C 453 143 C 519 232 A 627 216 A 841 191 C 1049 327 C 1469 189 C 1575 332 C 1832 480 HID H67 H52 H50 H59 H23 H58 H61 H12 H49 H63 H21 H40 H10 H39 H60 MEDIUM CENTERS ACADEMIC/ INFUSION UNIQUE COMMUNITY ENCOUNTERS PTS C 1963 322 C 2107 407 C 2156 993 C 2440 637 C 2549 776 C 2954 816 A 3258 265 C 3453 731 C 3518 883 C 3797 1161 C 3823 1125 A 3968 873 C 4203 991 A 4341 833 C 4558 1093 HID H27 H06 H38 H07 H46 H72 H62 H25 H24 H22 H69 H70 H26 H44 H43 LARGE CENTERS ACADEMIC/ INFUSION UNIQUE COMMUNITY ENCOUNTERS PTS C 4607 892 C 4767 714 A 4940 1197 A 4965 1064 C 5010 1360 C 5592 1148 A 6124 1143 A 6250 1162 C 6665 1034 C 6767 1733 C 6976 1265 C 7286 1080 C 7566 1700 C 8825 2179 C 9306 1075 The Most Frequently Asked Question • How many chairs per RN? • We prefer more specific numbers: – Number of patients per RN – Number of infusion encounters per RN Number of Chairs per RN Number of Patients per RN Number of Encounters per RN Patients for Other Staff ONCOLOGY-ONLY NAVIGATOR HID H66 H65 H36 H26 H06 H24 H49 Adj Mean ALL CENTERS H44 H69 H70 PATIENT COUNT 14 204 398 599 833 1145 1766 3889 4195 4358 27408 46800 ONCOLOGY-ONLY NUTRITIONIST HID PATIENT COUNT H66 28 H65 408 H24 1171 H06 1611 H22 1802 H21 2250 H08 3270 H70 3343 H26 3782 Adj Mean 4411 H67 6977 ALL CENTERS 7827 H72 23878 NON-PHYSICIAN PRACTITIONER HID H45 H65 H55 H56 H54 H48 H12 H52 Adj Mean H07 H59 H22 H60 H58 ALL CENTERS PATIENT COUNT 25 102 355 431 437 440 809 814 866 1064 1274 1802 2838 3264 4702 Patients for Other Staff TUMOR REGISTRY ONCOLOGY-ONLY FINANCIAL COUNSELOR HID H61 H62 H22 H70 H43 H23 H08 H68 H10 H21 Adj Mean H12 H06 ALL CENTERS H67 H42 H69 H26 H72 H39 H40 H38 H44 PATIENT COUNT 127 272 601 650 690 807 812 964 1088 1170 1310 1320 1567 1608 1642 1705 1754 1861 2312 2707 2837 3890 4358 HID H10 H49 H71 H36 H06 H51 H67 H63 H08 H07 Adj Mean H38-39-40-41-42 H64-65-66 H50 H45-46-47-48 H26 H24 H12 ALL CENTERS H43 H70 H25 H27 H21-22-23 CASES/FTE CTR 180 217 218 266 323 364 367 370 413 429 452 478 489 503 509 534 564 621 661 672 698 832 1622 2104 Number of Infusion/Injections Mixed Throughput: # of Encounters per Patient Number of Encounters per Breast Patient Number of Encounters per Benign Heme Patient Number of Active Treatment Hours per Encounter Number of Active Treatment Hours per Encounter – Benign Heme Number of Active Treatment Hours per Encounter - Colorectal Chair Occupancy Rate • Active treatment hours / available chair hours Pharmacy Utilization • Segregated out all J9 codes as those contain most of the oncology-related drugs • Top 10 J9 drugs administered (count of frequency of each code in billing data) • Percent of patients who received each drug • Average number of times each drug was administered to a patient Pharmacy Utilization – Breast Patients BREAST CANCER PATIENTS TOP 10 J9's AS % OF ALL J9's HCPCS CODE J9355 J9171 J9265 J9070 J9000 J9395 J9045 J9201 J9179 J9390 ALL CENTERS 25.1% 17.9% 12.7% 12.0% 8.7% 5.5% 3.8% 2.8% 2.7% 2.3% Mean 25.8% 11.6% 10.8% 11.8% 7.3% 14.0% 3.9% 3.6% 2.0% 2.0% % OF ALL BREAST PTS RECEIVING THIS DRUG ALL CENTERS 11.8% 11.8% 8.6% 15.3% 9.6% 4.3% 4.5% 2.1% 1.5% 1.2% Mean 15.6% 11.9% 10.4% 18.5% 9.7% 6.2% 5.7% 3.6% 1.3% 1.6% AVE. # TIMES GIVEN/PT # OF TX 9.9 7.1 6.9 3.7 4.2 6.0 3.9 6.1 8.7 9.3 Pharmacy Utilization – Colorectal Patients HCPCS CODE J9190 J9263 J9206 J9035 J9055 J9303 J9280 J9400 J9041 J9201 COLORECTAL CANCER PATIENTS TOP 10 J9's AS % OF ALL % OF ALL BREAST PTS J9's RECEIVING THIS DRUG ALL CENTERS Mean ALL CENTERS Mean 38.4% 24.6% 13.8% 13.3% 4.9% 2.8% 0.6% 0.3% 0.2% 0.1% 44.4% 25.4% 10.6% 13.0% 2.8% 2.2% 0.7% 0.2% 0.2% 0.1% 12.5% 0.1% 3.2% 30.0% 0.1% 10.9% 23.8% 2.1% 2.0% 0.1% 12.7% 0.0% 2.2% 36.1% 0.1% 9.5% 27.4% 2.7% 2.1% 0.0% AVE. # TIMES GIVEN/PT # OF TX 7.7 6.2 7.6 6.4 9.3 8.3 1.8 28.0 21.0 6.5 Heme-Oncs • Some centers have only “dedicated” heme-oncs • Some centers have only “private” heme-oncs • Some centers have a mix – These are excluded as it is impossible to match specific patients to specific physicians • Only oncology and benign hematology encounters are reported here Number of Encounters per Dedicated Heme-Onc Number of Encounters per Private Heme-Onc What’s New for 2015 NHOBS? • • • • • Lab data will be added Diagnostic imaging data will be added “Revenue” will be added Goal is to at least double the number of centers Let us know if you would like more information on how to participate and/or how to obtain more of the analysis: nhobs@oncologymgmt.com 2014 Report on 2013 Data All rights reserved © July 2014 Do not reproduce without permission Introduction • • The National Practice Benchmark™ was developed by Oncology Metrics, a division of Flatiron Health, Inc., a team of professionals with many years of experience in oncology practice, surveys, and benchmarking. Benchmarking is widely recognized as the best, most efficient way to find opportunities to improve your practice and then monitor progress after corrective action is taken. The National Practice Benchmark (NPB) provides important and meaningful data for oncology practices to use for managing in today’s challenging practice environment. This year we instituted eligibility criteria for participation in the NPB. Practices were eligible to participate if the could provide data for calendar year 2013 or their most recently completed 12-month fiscal year for the following: – – – – – – • # of full-time equivalent (FTE) physicians Total work relative value units (wRVU) # of new patients # of patient visits Cost of goods paid for (COGPF), also known as cost of drugs Total drug revenue Hospital-based and academic practices without access to cost of goods or drug revenue were given a “pass” and invited to complete the rest of the survey. 32 • • • Approximately 1,500 medical oncologists, practice administrators, and other key staff members from over 900 practices and institutions across the country were invited to participate in the 2014 National Practice Benchmark. Participants were invited via email and the survey was completed entirely online. Practices were instructed to submit only one survey per practice; multiple results from a practice were deleted. A total of 87 survey responses were submitted from practices in 34 states. The number of practices responding to individual questions varies. The National Practice Benchmark survey instrument collects data for a 12-month period. Practices were required to complete the core elements mentioned previously but not required to answer all questions; data from incomplete surveys is included in the final survey results. Data was submitted by hematology-oncology single specialty practices as well as by multi- specialty practices, hospital-based practices and other institutions. We report the number of responding practices as well as the number of full time equivalent (FTE) physicians for most data points in the survey. Some data are reported on the basis of FTE physician (HemOnc, RadOnc or physician); some are reported on the basis of Standard HemOnc (STD HemOnc) or Standard RadOnc (STD RadOnc). A STD HemOnc is one who generates 7,000 wRVU per year. A STD RadOnc is based on 26 average daily treatments. 33 • • Successful NPB survey participants receive a full survey report as well as a practicespecific benchmarking analysis. New this year - we are recognizing successful participants. “Oncology Metrics Certification” will be awarded to individuals who successfully complete the survey and “Oncology Metrics Recognition” will be awarded to their practices and will be recognized nationally in the publication in the fall of 2014. We believe that NPB participants who are able to provide complete and accurate data are among the best managed practices in the country. The ability of these practices to count what counts to keep their practices running efficiently distinguishes them as elite. If you are one of the successful NPB participants, congratulations and keep up the good work! And as you use this data in your practice, remember that “average” in this group is very good indeed. The National Practice Benchmark, 2014 Report on 2013 Data is expected to be published in the November, 2014 issue of the Journal of Oncology Practice. 34 Table of Contents Introduction 3 Respondent Demographics 9 Pharmacy Operations 18 Financial Benchmarks HemOnc productivity 23 Practice expense 32 Revenue & asset management 41 Staffing & productivity 59 Clinical Data Density 75 Radiation Oncology 82 About Oncology Metrics, a division of Flatiron Health, Inc. 98 About Altos Solutions, Inc., a division of Flatiron Health, Inc. 99 About Flatiron Health, Inc. 100 35 HemOnc Productivity • • • • New patients Work Relative Value Units (wRVU) Visit counts HemOnc Capacity Ratio 36 New Patients Total/FTE HemOnc (59 practices, 552 FTE HemOncs) New Patients Total/STD HemOnc (wRVU) (56 practices, 581.7 Std HemOnc wRVU) New patients, total New patient volume is an important measure of productivity and an essential tool for strategic planning. 450 400 350 Survey respondents reported the number of hematology/oncology new patients that entered the practice in the 12-month period by place of service (office or inpatient hospital). A new patient is defined as “one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care profession of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.” (CPT 2014) 37 300 250 200 150 100 50 0 25th 50th Adj Avg Avg 75th New patients, office 350 New patients, hospital New Patients Office/FTE HemOnc (59 practices, 552 FTE HemOncs) New Patients Hospital/FTE HemOnc (54 practices, 504.8 FTE HemOncs) New Patients Office/STD HemOnc (wRVU) (56 practices, 581.7 Std HemOnc wRVU) New Patients Hospital/STD HemOnc (wRVU) (52 practices, 540 Std HemOnc wRVU) 120 300 100 250 80 200 60 150 40 100 20 50 0 0 25th 38 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th Visit counts Office established patient visits include CPT codes 99212 – 99215. Office Est. Pt Visit/FTE HemOnc (57 practices, 521.7 FTE HemOncs) Office Est. Pt Visit/STD HemOnc (wRVU) (54 practices, 551.3 Std HemOnc wRVU) 4,000 3,500 Hospital established patient visits include CPT codes 99217-99220, 99231-99233, 9923499236, 99328-99239. Hospital Est. Pt. Visit/FTE HemOnc (57 practices, 521.7 FTE HemOncs) 1,200 Hospital Est. Pt. Visit/STD HemOnc (wRVU) (54 practices, 551.3 Std HemOnc wRVU) 1,000 3,000 800 2,500 2,000 600 1,500 400 1,000 200 500 - 25th 39 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th wRVU/ FTE HemOnc (56 practices, 537.1 FTE HemOncs) wRVU 10,000 The resource-based relative value system (RBRVS) assigns a relative value to each procedure code based on physician work, practice expense and professional liability expense. Relative value units (RVUs) are used by many payers to determine reimbursement for services and are available on the CMS website. 9,000 wRVU refers to the physician work component assigned to each code and is an important element of physician productivity measurement. This data represents total wRVU attributed to the physician for all services. 3,000 40 8,000 7,000 6,000 5,000 4,000 2,000 1,000 0 25th 50th Adj Avg Avg 75th wRVU, net incident to wRVU less incident to/FTE HemOnc (32 practices, 344.2 FTE HemOncs) wRVU less incident to/STD HemOnc (wRVU) (32 practices, 373.8 Std HemOnc wRVU) 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 25th 50th Adj Avg Avg 75th wRVU is reported here as net “incident to”; that is, any wRVU for services rendered incident to the physician service (not performed directly by the physician) is subtracted from total wRVU. 41 wRVU, E/M & infusion services, office 7,000 Office wRVU HO (E/M & infusion)/FTE HemOnc (55 practices, 508.8 FTE HemOncs) Office wRVU HO (E/M & infusion)/STD HemOnc (wRVU) (54 practices, 551.3 Std HemOnc wRVU) wRVU, E/M services only, office and hospital 9,000 wRVU HemOnc E&M Only/FTE HemOnc (56 practices, 537.1 FTE HemOncs) wRVU HemOnc E&M Only/STD HemOnc (wRVU) (56 practices, 581.7 Std HemOnc wRVU) 8,000 6,000 7,000 5,000 6,000 4,000 5,000 3,000 4,000 3,000 2,000 2,000 1,000 1,000 0 25th 42 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th wRVU, E/M services only, hospital Hosp wRVU HO (E/M)/FTE HemOnc (55 practices, 508.8 FTE HemOncs) Hosp wRVU HO (E/M)/STD HemOnc (wRVU) (54 practices, 551.3 Std HemOnc wRVU) 2,500 2,000 1,500 1,000 500 0 25th 43 50th Adj Avg Avg 75th HemOnc Capacity Ratio The HemOnc Capacity Ratio shows the productivity capacity of the hematology/oncology physicians to see more patients in addition to their current workload, based on the industry standard of 350 new patients per year or 7,000 wRVU per year. Significantly less 1 indicates existing capacity for the hematology/oncology physicians to see more patients. Near 1 means the HemOnc physicians are working near or at full capacity and growth in patient volume will require the addition of more physicians or nonphysician practitioners. 44 HemOnc Capacity Ratio (350 NP) (59 practices, 552 FTE HemOncs) HemOnc Capacity Ratio (7,000 wRVU) (56 practices, 537.1 FTE HemOncs) 1.40 1.20 1.00 0.80 0.60 0.40 0.20 25th 50th Adj Avg Avg 75th Revenue • Drug revenue • Net drug revenue • Revenue mix 45 Drug revenue, infusion pharmacy Drug Revenue (Infusion)/FTE HemOnc (54 practices, 529.6 FTE HemOncs) Drug Revenue (Infusion)/Std HemOnc (wRVU) (51 practices, 559.3 Std HemOnc wRVU) $5,000,000 $4,500,000 $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 $25th 50th Adj Avg Avg 75th Drug revenue is defined as total collected revenue for all drugs purchased and administered by the practice (J & Q codes). 46 Net drug revenue, infusion pharmacy Net Drug Revenue (Infusion)/FTE HemOnc (53 practices, 569.1 FTE HemOncs) Net Drug Revenue (Infusion)/Std HemOnc (wRVU) (50 practices, 559.3 Std HemOnc wRVU) $1,000,000 $900,000 $800,000 $700,000 $600,000 $500,000 $400,000 $300,000 $200,000 $100,000 $25th 50th Adj Avg Avg 75th Net drug revenue is total drug revenue less COGPF (cost of goods paid for). This is a much more realistic way to look at drug revenue for the practice. 47 Revenue Mix Hematology/oncology Other Medical Rev 18% Rev, non-medical 2% Net Drug Rev (Infusion) 32% Clinical Trial Rev 1% Laboratory Rev 3% Imaging Rev 10% Infusion Rev 15% Net Drug Rev (Point of care pharm) 3% E/M Rev 16% Revenue mix is reported as the adjusted average per STD HemOnc and includes all practices reporting in each category; the number of respondents varies from one category to the next. 48 Staffing & Productivity • All staff positions are reported as full-time equivalents (FTE). An FTE staff is someone working 40 hours per week or 2,080 hours per year. An FTE is calculated by dividing the number of hours worked per week by 40. • Some staff positions may be counted in more than one category but no staff position should be counted as more than 1 FTE. • Staff may be reported for all departments/specialties (per FTE physician) or for the hematology/oncology line of business (per FTE HemOnc). 49 FTE Staff All includes staff working in all departments/specialties in the practice. Includes all staff; does not include physicians. FTE Staff HemOnc includes all staff working in the hematology/oncology line of business. Includes all staff; does not include physicians. FTE Staff HemOnc/FTE HemOnc (52 practices, 465.2 FTE HemOncs) FTE Staff HemOnc/Std HemOnc (wRVU) (49 practices, 494.8 Std HemOnc wRVU) FTE Staff All/FTE Physician (52 practices, 579.1 FTE Physicians) 12.0 14.0 10.0 12.0 8.0 10.0 8.0 6.0 6.0 4.0 4.0 2.0 2.0 - 25th 50 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th Staff pay/physician Pay Staff All Pay Staff HemOnc Pay Staff All/FTE Physician (51 practices, 579.1 FTE Physicians) $600,000 Pay Staff HemOnc/FTE HemOnc (50 practices, 462.4 FTE HemOncs) Pay Staff HemOnc/Std HemOnc (wRVU) (47 practices, 492 Std HemOnc wRVU) $600,000 $500,000 $500,000 $400,000 $400,000 $300,000 $300,000 $200,000 $200,000 $100,000 $100,000 $- $25th 51 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th Non-physician practitioners (NPP) FTE NPP 0.90 Pay/FTE NPP HemOnc FTE NPP HO/FTE HemOnc (44 practices, 429 FTE HemOncs) FTE NPP HO/STD HemOnc (wRVU) (43 practices, 468.3 Std HemOnc wRVU) Pay/FTE NPP HO (42 practices, 279.6 FTE NPPs) $120,000 $100,000 0.80 0.70 $80,000 0.60 $60,000 0.50 0.40 $40,000 0.30 0.20 $20,000 0.10 - $25th 52 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th NPP Productivity NPP wRVU/HemOnc NPP wRVU/NPP NPP HO wRVU/FTE NPP HO (35 practices, 231.1 FTE NPPs) NPP wRVU/FTE HemOnc (40 practices, 450.2 FTE HemOncs) 1,600 NPP wRVU/Std HemOnc (wRVU) (40 practices, 491 Std HemOnc wRVU) 3,500 3,000 1,400 1,200 2,500 1,000 2,000 800 1,500 600 1,000 400 500 200 0 0 25th 53 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th Laboratory FTE Lab/FTE Physician (41 practices, 451.4 FTE Physicians) Lab Revenue/FTE Lab (37 practices, 313.9 FTEs Lab) $225,000 0.9 $200,000 0.8 $175,000 0.7 $150,000 0.6 $125,000 0.5 $100,000 0.4 0.3 $75,000 0.2 $50,000 0.1 $25,000 0.0 $25th 54 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th Research FTE Research/FTE Physician (31 practices, 428 FTE Physicians) 0.7 Clin Trial Revenue/FTE Research (27 practices, 236.9 FTEs Research) $100,000 $90,000 0.6 $80,000 0.5 $70,000 $60,000 0.4 $50,000 0.3 $40,000 $30,000 0.2 $20,000 0.1 $10,000 0.0 $25th 55 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th Imaging FTE Imaging/FTE Physician (21 practices, 377.6 FTE Physicians) 0.6 Imaging Revenue/FTE Imaging (21 practices, 207.8 FTEs Imaging) $1,000,000 $900,000 0.5 $800,000 $700,000 0.4 $600,000 0.3 $500,000 $400,000 0.2 $300,000 $200,000 0.1 $100,000 0.0 $0 25th 56 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th FTE chemo admin staff includes all staff responsible for drug purchasing, drug mixing and preparation, delivery to patients, documentation of services provided, and management of these processes. Staff is included in proportion to the amount of time spent on chemotherapy management activities. FTE Chemo Admin/FTE HemOnc (52 practices, 480.2 FTE HemOncs) FTE Chemo Admin/Std HemOnc (wRVU) (49 practices, 495.3 Std HemOnc wRVU) Pay/FTE Chemo Admin (50 practices, 789.7 FTEs Chemo. Admin.) $80,000 3.5 $70,000 3.0 $60,000 2.5 $50,000 2.0 $40,000 1.5 $30,000 1.0 $20,000 0.5 $10,000 0.0 $0 25th 57 50th Adj Avg Avg 75th 25th 50th Adj Avg Avg 75th Chemo admin staff productivity Initial Infusion/FTE Chemo Admin (52 practices, 792.5 FTEs Chemo. Admin.) 900 800 700 600 500 400 300 200 100 0 25th 50th Adj Avg Avg 75th Initial infusions is a count of the initial drug administration codes billed by the practice during the period and includes CPT codes 96360, 96365, 96369, 96374, 96409, and 96413. This is a surrogate for the number of patients receiving infusion services and may be used as a measure of productivity in the infusion suite. 58 Clinical Data Density • To measure clinical practice and support outcome measurement, it is necessary to capture key clinical data at various points during therapy. Six key clinical indicators (what we call the “Big6”) are essential to any organized data analysis. The Big6 include staging, intent of therapy, toxicity, disease status, performance status and line of therapy. • The 2014 NPB survey, for the first time, queried respondents about their ability to report on the Big6. Respondents were asked two questions: – What percentage of patients seen in the 12-month period had the specified element recorded in a defined field in the EMR; and – Whether their response was based on an estimate or an actual measurement. • We believe that the ability to measure the degree to which these data are present in defined fields in the EMR is highly correlated with clinical consistency and responsible management of therapy for treated patient populations. 59 Staging 35 30 # of respondents 25 20 Measured 38% 15 10 Estimated 62% 5 0 90-100% 50-89% <50% Percentage of patients What percentage of patients seen by a physician with a primary cancer diagnosis for which staging is common have staging information recorded in a defined field in the EMR? 60 Intent of therapy 35 30 # of respondents 25 20 Measured 38% 15 10 Estimated 62% 5 0 90-100% 50-89% <50% Percentage of patients What percentage of patients seen by a physician who had therapy initiated or had a change of therapy have the intent of therapy recorded in a defined field in the EMR at least one time? 61 Toxicity assessment 30 # of respondents 25 20 Measured 29% 15 10 Estimated 71% 5 0 90-100% 50-89% <50% Percentage of patients What percentage of patients seen by a physician who were on active chemotherapy have a toxicity assessment recorded in a defined field in the EMR at least one time? 62 Disease status 30 # of respondents 25 Measured 24% 20 15 10 Estimated 76% 5 0 90-100% 50-89% <50% Percentage of patients What percentage of patients seen by a physician who had therapy initiated or had a change of therapy have disease status recorded in a defined field in the EMR at least one time? 63 Patient performance status (ECOG or Karnofsky) 35 30 # of respondents 25 Measured 31% 20 15 10 Estimated 69% 5 0 90-100% 50-89% <50% Percentage of patients What percentage of patients seen by a physician who were on active chemotherapy had the patient performance status recorded in a defined field in the EMR at least one time? 64 Line of therapy 30 # of respondents 25 20 Measured 29% 15 10 Estimated 71% 5 0 90-100% 50-89% <50% Percentage of patients What percentage of patients seen by a physician who had therapy initiated or had a change of therapy had the line of therapy recorded in a defined field in the EMR at least one time? 65 Thank You! Teri U. Guidi, MBA, FAAMA Oncology Management Consulting Group tguidi@oncologymgmt.com nhobs@oncologymgmt.com Elaine L. Towle, CMPE Oncology Metrics, a division of Flatiron Health, Inc. etowle@oncomet.com