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ASCOʼs Quality-Improvement Program Adds Certification Component

2009; Wolters Kluwer; Volume: 31; Issue: 16 Linguagem: Inglês

10.1097/01.cot.0000360400.21168.a2

1548-4688

Lola Butcher,

Economic and Financial Impacts of Cancer

The Quality Oncology Practice Initiative (QOPI), the three-year-old quality-improvement program sponsored by the American Society of Clinical Oncology, has expanded to include a certification program for oncology practices. The new program will help position hematology-oncology and medical oncology groups to participate in one of the strongest trends in the business of health care: value-based purchasing. Tired of paying equal money to good and poor providers alike, government and private payers want to financially reward high-quality physicians while penalizing those who do not follow best practices. That requires a way for payers to identify top performers. The QOPI certification program (http://qopi.asco.org) will recognize medical practices that meet specific performance requirements and pass a site assessment. While payers ultimately want to reward physicians for patient outcomes, the QOPI program, which evaluates a practice's processes and infrastructure, is a step in that direction. “We have had great interest from members asking that their QOPI participation be made known to third-party payers,” said ASCO President Douglas W. Blayney, MD. “So we expect to see great interest in certification.” History of QOPI QOPI was founded in 2002 when ASCO agreed to support a small team of physicians who wanted to promote a quality-improvement culture within America's oncology practices. OT columnist and Editorial Board Member Joseph V. Simone, MD, who had chaired the Institute of Medicine's National Cancer Policy Board when it published the Ensuring Quality Cancer Care report, initiated the idea after reflecting on the variation among oncology practice patterns. “I knew that there were high-quality practices that gave serious consideration to the quality of the care they provided, and I identified some of those practices,” said Dr. Simone, now Director of the University of Florida-Shands Cancer Center. “And then I ran into others that were mostly financially motivated. There was a dichotomy.” After a pilot of 23 practices, ASCO opened the QOPI program to its members in 2006. Nearly 500 practices—mostly independent private practices—submit performance data to the program for at least one of the two reporting periods each year. ASCO analyzes the data to determine how well a practice adheres to more than 80 evidence-based and consensus standards. Each practice receives a confidential report on how its performance compares with the standard—and how the practice compares with its QOPI peers. Using the Feedback Reports Oncology practices can use the QOPI feedback reports to determine where to put their quality-improvement efforts. For example, when the University of Michigan Comprehensive Cancer Center found that, in the first four QOPI rounds, its physicians complied with pain assessment standards in more than 90% of their cases, practice leaders decided not to devote resources to reporting that measure in the Spring 2008 round. On the other hand, the QOPI reports for the early data-collection periods revealed that UMCCC's use of chemotherapy within two weeks of death was significantly higher than other practices. That finding immediately got the physicians' attention. “They were surprised that we never measured that before, and they found it interesting,” said Dr. Blayney, UMCCC's Medical Director. The physicians had some theories that might explain the high chemotherapy use, but they were highly influenced by learning how far they deviated from their peers. For the next reporting period, UMCCC's use of chemotherapy at the end of life declined from 50% to 20%, as reported in a study now available online ahead of print in the Journal of Clinical Oncology by Dr. Blayney and his coauthors Kristen McNiff, David Hanauer, Gretchen Miela, Denise Markstrom, and Michael Neuss.Figure: ASCO President DOUGLAS W. BLAYNEY, MD: “We've had great interest from members asking that their QOPI participation be made known to third-party payers, so we expect to see great interest in certification.”The QOPI program was designed to appeal to physicians' intrinsic motivations, Dr. Simone noted. “Doctors are basically competitive, so they want to know how they're doing compared with peers. And doctors are data-driven—you can tell them they are doing poorly, but unless you can show them some data, they are not going to believe you.” Key to QOPI's Acceptance Physicians are particularly suspicious of reporting initiatives established by health plans because they fear payers will disguise a cost-saving program as a quality program. Dr. Simone said he believes that the fact that physicians created and maintain QOPI has contributed to its acceptance even though oncology practices receive no financial incentives to offset the costs associated with participation. “Up to this day, volunteers develop the measures and control the data,” he said. “I felt the only way we could get doctors to participate is if they had some control over it and decision-making authority.” How Certification Works Oncology practices that participate in the Fall 2009 QOPI data-collection process will be eligible to seek certification next year, but certification is optional; the original QOPI system will continue to operate as it has. The scoring rubric to achieve certification has not yet been finalized, but Dr. Blayney said practices that score among the top 85% of QOPI participants on a subset of important quality measures will be candidates for certification. “We have data showing that, overall, oncology care in this country is of high quality, so our steering group felt comfortable setting the bar at an 85% pass rate,” he said. However, there is no penalty for not submitting a score. “The whole point of this is to measure one's performance, and if it's not up to the benchmark, you know how to improve it,” he said. “When the score hits the benchmark, you can submit it.” ASCO will audit a sample of the QOPI data submitted by certification applicants each year. The society will not report scores publicly or make them available to payers. ASCO-ONS In addition to documenting high performance on the QOPI measures, practices must show that they comply with standards for safe chemotherapy administration in the outpatient setting codified by ASCO and the Oncology Nursing ociety. “The new chemotherapy standards will provide practices with steps to maximize patient safety,” said Kris LeFebvre, MSN, RN, AOCN, a project manager on ONS's Education Team. An ASCO-ONS steering committee mapped the route that patients take during chemotherapy treatment, and then convened a group of physicians, nurses, pharmacists, patient representatives, and social workers to develop standard processes for each point on that journey. More than 300 people responded to the proposed standards during a public-comment period. Committee members expected to publish the final standards online on the ASCO and ONS Web sites as early as this month. Although the standards will support the QOPI certification program, their broader purpose is to provide a benchmark that all chemotherapy providers should hit. “Having everyone work from the same basic rules will help to increase patient safety and improve the care that the patients are going to receive,” she said. www.oncology-times.com