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Martyrs for Better Care

2012; American Society of Clinical Oncology; Volume: 8; Issue: 6 Linguagem: Inglês

10.1200/jop.2012.000794

1935-469X

John V. Cox, Elaine L. Towle,

Healthcare cost, quality, practices

This issue of Journal of Oncology Practice provides a double dose of hefty content.In addition to our usual content, this issue presents special supplemental material.Anchoring the "State of Oncology Practice" supplement is the full data set report collected, collated, and analyzed by principles of Oncology Metrics, a division of Altos Solutions, Tom Barr and Elaine Towle (who also is a consulting editor to JOP).In September's JOP, Barr and Towle presented an overview of these data and examined trends compared with multiple years of information the authors have collected about the economics and processes of oncology practice. 1They noted that largely all the metrics were flat year after year, providing some solace to oncology practices that have been seeing declines in marginal revenue for some years.And there were hints of change, notably the shift of some independent practices into institutions, resulting in the inability of these practices to share a complete data set because they no longer had control over the data or reporting functions.Many survey respondents, however, did provide complete and detailed data, and readers can use this complete 2011 practice data set to benchmark their practice.As mentioned in September, this is a unique data set, for which we are indebted to the authors and to the several practices that submitted data to the effort.JOP regularly presents information about health care policy, efforts at reform, and our profession's response.In a May supplement (copublished with the American Journal of Managed Care), Sprandio et al updated his work on an oncology medical home. 2,3Applying the principles of process improvement to a degree rarely seen in oncology, he drove his practice to refocus on patient needs and quality outcomes.He improved access and focused on avoiding emergency room visits and hospitalizations by putting into place maneuvers to better manage these events.He created a robust set of metrics and a "dashboard" overlay with his electronic health record that turned these metrics into actionable data that drove better care.Transforming data collection to actionable clinical decision support decreased chemotherapy being provided to patients who were at most risk of toxicity and least likely to benefit.A huge challenge faced Sprandio's practice, however.Despite the success of his patient-centered approach, his payers did not pass on the savings realized through the practice's efforts.The practice revenue was still tied to a fee-for-service model, and because the practice saw a decrease in the overall volume of services provided, revenues dramatically declined despite the fact that he was providing better care by every measure.Visionaries are sometimes martyred; thankfully Sprandio still lives and leads.