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
Federal Initiatives
Federal Initiatives
Federal Initiatives
Federal Initiatives
Federal Initiatives
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
–
–
Patient satisfaction
–


With benchmarking
With benchmarking
Create a template for viable payment
•
Private payers
•
Medicare
Help practices implement
•
Process change
•
Payer contracting
•
Accreditation
•
IT Solutions
Oncology Medical Home Summary
Model
Identify
Stakeholder Needs
Define Model
Elements
Measurement
Implementation
Develop
Payment
Quality/Value Identify Vendors
Measures
Develop
Develop Patient
Certification/Recog
Satisfaction Tool
nition
Categorize Tools
Develop Practice
Implementation
Guide
Identify Viable
Payment Models
Develop Private
Payer Templates
Develop
Medicare Model
Oncology
Medical Home
IT Advisory Team Representation
Industry Representation
Practice Representation
Altos
Florida
COA
Georgia
CoC
Ohio
COME HOME
Texas
Elekta
FlatIron
iKnowMed
Net.Orange
Unlimited Systems
Varian
Oncology Medical Home
Oncology Medical Home
Oncology Medical Home
Oncology Medical Home
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:
http://www.medicalhomeoncology.org/coa/register.htm
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 4th, 2015
14 Benchmarking/Survey Reports
Example: Summary Scoring
Patient Satisfaction Surveys
Question
In the last 12 months, how many
days did you usually have to
wait for an appointment when
you needed care right away?
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
Same day
1 day
2 to 3 days
4 to 7 days
More than 7
days
50%
23.6%
16.5%
5.7%
2.7%
Median Result
Always
Usually
Sometimes
Never
71.4%
21.0%
5.9%
1.6%
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, definitely
92.7%
Yes, somewhat
6.4%
No
0.7%
In the last 12 months, how often did
this provider spend enough time with Always
you?
Usually
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
80.5%
16.4%
Sometimes
2.1%
Never
0.4%
Median Result
Always
61.8%
Usually
23.4%
Sometimes
7.9%
Never
4.0%