Summary of the Performance Measurement Workgroup Conference Call
September 20, 2007
Participants
Frank Opelka, ACS, chair
Mark Antman, AMA
Priscilla Arnold, ASCRS
Bruce Bagley, AAFP
Albert Bothe, AAMC
Helen Burstin, NQF
Jim Christina, APMA
Ellen Clough, SOTS
Cheri Digiovanni, Ingenix
Denise Dodero, AAMC
Mayra Ferreira, PRCH
Shelley Fichtner, PhRMA
Leanne Gardner, ACP
Andrea Gelzer, Boston Medical Center
Health Net Plan
Mark Gordon, ACR
Daniel Green, CMS
Jenissa Haidari, AAOHNS
James Hayman, ASTRO
Sam Ho, Untied Healthcare
Mike Hogan, STS
Elizabeth Hoy, ACS
Christine Izui, BCBSA
Erin Kaleba, AMA
John Kucharczuk, STS
Lisa Latts, WellPoint
Flora Lum, AAO
Carole Magoffin, NMQF
Sharon McGill, AOA
Kristin McNiff, ASCO
Ariz Mehta, AAPMR
Debbie Robin, AGA Institute
Christopher Rose, ASTRO
Jaqueline Sallee, WellPoint
Cary Sennett, ABIM
Cynthia Shewan, STS
Amy Topel, WCHQ
Allison Villa, AHIMA
Richard Weiss, Maximus
Emily Wilson, ASTRO
Cameron Wright, STS
Introduction
Dr. Frank Opelka welcomed participants to the call and reviewed the agenda – to review
and discuss the oncology and general thoracic surgery measures.
Review and Discuss Oncology Measures
Erin Kaleba from the AMA PCPI gave an overview of the oncology measures set for
medical and radiation oncology. The call participants opted to review the measures
individually. Dr. Patty Ganz and Kristin McNiff, representing ASCO, and Dr. James
Hayman of ASTRO also responded to questions from call participants.
Measure 1: Cancer Staging
 The measure collects the stage of cancer for breast colon and rectal cancers.
 This measure differs from the measure not approved by the AQA in January. The
previously rejected measure had 13 diagnosis codes and included the disease status
codes for PVRP (g-codes).
 The measure uses the AJCC (American Joint Committee on Cancer) collaborative
staging system, which was developed as part of CMS’ cancer demonstration project.
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The measure is listed as accountability measures applicable to any physician,
radiation therapist or medical oncologist.
The measure tests the cognitive skills of the physician which involves combining
various medical indicators (level of metastatic disease and lymphatic involvement) to
indicate stage of illness.
Vote:
No: zero, Abstentions: NMQF (the measure formulation is lacking sufficient evidence
for minority populations); PRCH (organization is not a medical specialty society)
Ingenix. Yes: majority. The measure was approved for review by the full AQA at the
October meeting.
Measure 2: Hormonal therapy for stage IC-III, ER/PR positive breast cancer
This measure was previously approved by the AQA in January 2007. A change to the
measure was made to more accurately define the denominator. The NQF has approved a
similar system-level measure.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Measure 3: Chemotherapy for stage III colon cancer patients
This measure was also approved by the AQA in January 2007. The measure is specified
here with CPT II code criteria rather than g-codes. The NQF has approved a similar
system level measure.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Measure 4: Plan for Chemotherapy Documented
The AQA had also previously approved this measure. It was noted that the measure is
not specialty specific and applies only to the treatment plan for chemotherapy (not for
any other cancer treatment). The measure developer noted that there was an identifiable
gap in documentation of the plan of care for chemotherapy in the 81-84% range.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Measure #6: Treatment Summary Communication – Radiation Oncology
This measure was newly developed in the AMA PCPI process. The measure assesses
communication among medical providers. One participant suggested the need for a
measure to assess communication to a patient.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Measure #7: Normal tissue dose constraints specified
The measure assesses the percentage of patients with a diagnosis of cancer receiving 3D
conformal radiation therapy with documentation in medical record that normal tissue
dose constraints. The measure seeks to reduce damage to normal tissue during radiation
therapy.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Measure #8: Pain Intensity Quantified-Medical Oncology and Radiation Oncology
Dr. Gantz noted that the AMA PCPI Workgroup felt strongly that there is not a uniform
pain assessment standard and end of life pain should be assessed. The PCPI Workgroup
found that pain was most likely to be assessed in the later stages of disease and just prior
to death.
One call participant stated that it would be more patient-centered if the measure assessed
pain for all cancer patients rather than those just receiving chemotherapy and radiation, as
written in the measure denominator. Dr. Gantz responded that the development group
did consider this but they decided that the added burden of reporting on every patient
would be too great.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Measure #9: Plan of Care for Pain-Medical Oncology and Radiation Oncology
Dr. Gantz presented the plan of care measures. The Workgroup decided that this measure
should only move forward if it is paired with measure eight.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Review and Discuss Measures for General Thoracic Surgery
Dr. John Kucharczuk and Dr. Cameron Wright gave a brief overview of the STS general
thoracic surgery measures.
General Comments:
 It was not clear to one participant how these measures would be reported – the only
options are through the STS database or medical record review.
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Drs. Juchareczuk and Wright noted that any provider who conducts the procedures
could report on the measures. It would be easier to do through the STS database, but
it is not exclusive.
Another participant questioned whether or not the measures went through a formal
public comment period, as recommended in the AQA Parameters for Selecting
Measures for Physician Performance.
Drs. Juchareczuk and Wright stated that the measures were distributed to AQA
participants at the May meeting as proposed measures. They acknowledged that this
was not a formal comment period, but they did release the measures for public
review.
Another participant stated they did not have objection to creating and vetting registry
measures. However it should be stated that registry measures are of limited use, as not
all physicians will be able to use and report measures via a registry.
Measure 1: Pulmonary function tests before major anatomic lung resection
Drs. Kuchareczuk and Wright noted the gap in completion of the preoperative pulmonary
function test of about 25%. The measure applies to major anatomical resections. In many
cases, the results of the pulmonary function test will result in a decision not to operate.
The measure stipulated that the test should take place within the 12 months prior to
surgery.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Measure 2: Recording of clinical stage for lung cancer & Esophogeal resection
The doctors noted that the gap in documentation of clinical stage was very high. A
surgeon cannot treat a patient without knowing the stage of the cancer. If a cancer stage
is not correct it may result in inappropriate care.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Measure 3: Specifications for smoking status
The Doctors noted that assessment of smoking status had a major effect on surgery
outcomes, including hospital length of stay. The patient’s smoking status also influences
the decision to operate and the risk level of the patient. The gap in questioning patients is
about 15-20%
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Measure 4: Recording of performance status (Zubrod, Karnofsky, World Health
Organization or Eastern Cooperative Oncology Group Performance Status) prior to lung
or esophageal cancer resection
This performance status is a strong predictor of patient morbidity and mortality. The
measure allows for the use of four different performance status scales. The status
indicates to the thoracic surgeon whether or not the patient should undergo the given
procedure.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.
Measure 5: Participation in a national database – participating physician
The purpose of this measure is to demonstrate that the physician participates in a clinical
registry that supplies feedback and benchmarks to the physician. The measure does not
specify any particular registry. Many participants thought that the registry’s components
should be standardized. Another participant also noted that without standards to audit
and validate the data, it was hard to understand how participation in the registry would
improve care.
Vote:
No: zero. Abstentions: NMQF, PRCH, Ingenix, AAMC. Yes: majority. The measure was
approved for review by the full AQA at the October meeting.