Measuring Quality and Value in Oncology. The Need for Measurement Payers (Medicare and private...
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Transcript of Measuring Quality and Value in Oncology. The Need for Measurement Payers (Medicare and private...
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Measuring Quality and Value in Oncology
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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
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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?
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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
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Federal Initiatives
Physician Quality Reporting System (PQRS) Meaningful Use of Electronic Health Records
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Federal Initiatives
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Federal Initiatives
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Federal Initiatives
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Federal Initiatives
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Federal Initiatives
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Federal Initiatives
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Federal Initiatives
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The McNamara Fallacy
Just because you can measure it, doesn’t mean it is relevant, important, or informative
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The COA OMH Game Plan Create general consensus and unity among stakeholders
• Patients
• Payers
• Providers
Agree on quality and value• Measures
– With benchmarking
– Patient satisfaction
– With benchmarking
Create a template for viable payment• Private payers
• Medicare
Help practices implement• Process change
• Payer contracting
• Accreditation
• IT Solutions
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Model
Identify Stakeholder Needs
Define Model Elements
Develop Certification/Recognition
MeasurementImplementation
Identify Vendors
Categorize ToolsDevelop Practice Implementation Guide
Payment
Identify Viable Payment ModelsDevelop Private Payer TemplatesDevelop Medicare Model
Develop Quality/Value Measures
Develop Patient Satisfaction Tool
Oncology Medical Home
Oncology Medical Home Summary
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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
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Oncology Medical Home
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Oncology Medical Home
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Oncology Medical Home
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Oncology Medical Home
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Oncology Medical Home
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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
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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
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14 Benchmarking/Survey Reports
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Example: Summary Scoring
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Patient Satisfaction SurveysQuestion Median Result
In the last 12 months, how many days did you usually have to wait for an appointment when you needed care right away?
Same day 50%1 day 23.6%2 to 3 days 16.5%4 to 7 days 5.7%More than 7 days
2.7%
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
Always 71.4%Usually 21.0%Sometimes 5.9%Never 1.6%
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Patient Satisfaction SurveysIn 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 you?
Median Result
Always 80.5%
Usually 16.4%
Sometimes 2.1%
Never 0.4%
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
Always 61.8%
Usually 23.4%
Sometimes 7.9%
Never 4.0%