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Navigating the Quality Landscape in Oncology: Pitfalls and Lessons Learned

Surabhi Dangi-Garimella, PhD
Ensuring access to appropriate data and then using the information to improve healthcare outcomes remains an ongoing challenge-this was the conclusion drawn by panelists participating at the National Comprehensive Cancer Network’s Oncology Policy Summit on Redefining Quality Measurement in Oncology.
When the moderator, Clifford Goodman, PhD, The Lewin Group, asked whether CMS has been thinking about these specific measures, York said that the Center for Medicare & Medicaid Innovation started looking at outcomes measures, but the requirement was for infrastructure changes to ensure ramping up of quality-based programs.

“Our measures were closest to outcomes measures,” he said, adding that while they were process measures, they were geared to collect healthcare utilization metrics. Citing an example of pain as an outcomes measure, he said “We need to include a process measure to ensure [pain medication] was being administered.”

When asked if the existing quality measurement apparatus is suitable for quantifying patient experiences with quality of their treatment, Walters replied in the negative.

Griggs narrated her experience at Michigan with patient interaction: measuring anxiety, stress, and non–cancer-related issues. “The 17 measures that evolved following their patient interaction lined-up well with ASCO [American Society of Clinical Oncology]’s measures submitted under the Merit-based Incentive Payment System.” While these measures have been identified, operationalizing them, is the next step, she said.

“We can actually collect data on switching doctors and the chemotherapy administered in the last 14 days of care … that could be incorporated as a quality measure,” Walters said.

Smith believes that care coordination soon will be included as a quality measure and that precision medicine will help this. Health plans have already been thinking about this. “We have a care management fee in our oncology home model, which is equivalent to the MEOS [monthly enhanced oncology service] payment," under OCM, which helps ensure care coordination receives monetary support.

“We have the medical oncologist targeted as our care coordinator,” York explained, because often the primary care providers aren’t ready to take up that responsibility. He explained though that care navigation can be spread out across the practice to include the nurse navigator, the front office administrator, and the oncologist.

When asked about dealing with patient dissatisfaction when they do not receive the treatment they seek because it may not be supported by evidence, Walters explained that it may not affect quality measurement because “many measures have denominator exclusions that includes documentation on why the patient was refused.”

Explaining the industry’s struggle with sharing real-world evidence that supports the value proposition of their product, Spangler said, “We have limitations on how much of the real-world evidence that we gather can be shared with other stakeholders.” This evidence, he suggested, can definitely be included in the development of quality measures.

“We need a parsimonious tight set of meaningful measures that can be used by both health systems and patients,” said Griggs.

“Collective accountability is vital: everyone needs to work together to improve the quality of care,” added Spangler.

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