Quality measures are the lifeblood of practice transformation, but learning which ones make a difference—and how to use them to drive change—is as much an art as a science, according to 3 oncology care leaders who discussed the topic Friday at the 2022 Community Oncology Conference, presented by the Community Oncology Alliance.
Quality measures are the lifeblood of practice transformation, but learning which ones make a difference—and how to use them to drive change—is as much an art as a science, according to 3 oncology care leaders who discussed the topic Friday at the 2022 Community Oncology Conference, presented by the Community Oncology Alliance (COA).
Panelists Stephen Schleicher, MD, MBA, chief medical officer at Tennessee Oncology and medical director for Value-Based Care for OneOncology, and Lalan Wilfong, MD, vice president for Payer Relations and Practice Transformation at The US Oncology Network and a longtime medical oncologist at Texas Oncology, joined moderator Alti Rahman, MBA, MHA, practice administrator for Oncology Consultants in Houston, Texas, for a session that covered gathering data and deploying it within a practice.
As Rahman explained, numbers on a dashboard don’t drive change all by themselves. He described a “transitional phase,” which is as much about conversations as the data themselves. Physicians, nurses, and other staff must be educated on why data collection matters and how it can drive better patient care and improve the bottom line. It’s not a process that happens overnight, they said.
As Schleicher put it, getting data into a dashboard is the easy part. “The hard part is to get people to do something different.”
The panelists agreed that starting out slowly, with a focus on a few key measures that can identify “outliers,” is a good way to get buy-in without overwhelming care teams.
Both stressed the importance of involving diverse stakeholders from across a practice. Wilfong said deciding who needs to be involved is important, and so is strong leadership.
“At times, leadership has to say, ‘I know this isn’t pleasant, but we have to do it.’”
What happens, Rahman asked, when there is disagreement?
Schleicher advised that those who will be affected by a quality measure should have opportunities to weigh in on how they will be used. Each metric may be very important to some staff members and less important to others.
Wilfong said some metrics—such as how long it takes to schedule patients for appointments—must be monitored every day. But for other measures, including those that affect physicians, it may be better to measure less frequently, so that a single uncommon event such as a patient death doesn’t skew results. Schleicher said the question of how frequently to report metrics to fellow clinicians and the staff is one he’s still trying to answer.
“We’ve settled on quarterly for an extensive report,” he said.
Wilfong agreed. “Physicians don’t want stuff in front of them every single day.”
Rahman explored the merits of positive and negative reinforcement. Sending out emails that show physicians how they rank among their peers will often spark change among a group that is competitive by nature. But tying quality measures to compensation, such as a portion of the annual bonus, may be necessary.
Bonuses can be added dollars if quality measures improve, but they can also involve taking money if measures are poor. Wilfong said sometimes that’s what gets physicians to pay attention. “For some doctors, if you take one dollar away they completely freak out.”
Schleicher spoke at length of the care he takes in communicating subpar results. The process shouldn’t be about shaming people, but about having a conversation on why an individual physician is using a more expensive medication when a cheaper one will work. He said it’s important to realize that for many physicians, being compared to their peers is a relatively new concept.
“Before OneOncology had the tools to do this,” most clinicians had no idea how their resource utilization compared to others, “whether they were average or an outlier.”
Wilfong said The US Oncology Network did an exercise that compared physician behavior in a fee-for-service environment with a risk-based model. Doctors went from thinking about an extra PET scan as something they could bill for to something that might cost them money. “As we take on more risk the paradigm changes,” he said.
Schleicher emphasized the need to take things slowly, to balance driving change with ensuring the data are accurate. If a physician is told he is an outlier in a metric and the data turn out to be wrong, trust is damaged. “Don’t send anything out if you’re not 100% confident,” he said. “If the quality is not there, it’s really hard to make up for it.”