The American Society of Clinical Oncology (ASCO)
testified yesterday at a hearing of the House Energy and Commerce Subcommittee on Health on issues related to cancer care quality.
The Committee held the two-day hearing to review physician payment issues and pay-for-performance programs. The first part of the hearing, held Tuesday, focused on the impending 4.6% physician fee schedule reductions planned for 2007 and proposals to tie future physician payment updates to current or future pay-for-performance programs.
Yesterday’s hearing focused on the numerous quality initiatives specialty societies have already undertaken. It also featured Mark McClellan, MD, Administrator of the Centers for Medicare and Medicaid Services (CMS), who reviewed CMS’ attempts to better align the Medicare payment system with quality initiatives.
Deborah Schrag, MD, MPH, a medical oncologist and researcher at Memorial Sloan-Kettering Cancer Center, and past Chair of ASCO’s Health Services Committee, testified on behalf of ASCO. Dr. Schrag overviewed ASCO’s quality cancer care initiatives and urged the Committee to support extension of the CMS 2006 oncology demonstration project.
CMS set up the one-year demonstration project at the beginning of 2006 to gather information on the patient’s stage of disease, the reason for treatment, and whether treatment followed evidence-based guidelines developed by ASCO and the National Comprehensive Cancer Network (NCCN). The demonstration is preserving critical resources in the cancer care system and the most useful data will only be derived from a multi-year effort.
Dr. Schrag outlined the need for a cancer care “treatment summary,” and appropriate reimbursement for this service. The summary is a written document that would capture in a succinct format the patient’s treatment history and plan for follow-up care. The treatment summary is intended to improve communication and coordination of care among oncologists, patients, and other health care providers.
The questions from the Committee members on both days focused on the need for Congress to fix the flawed physician payment formula, how quality measures are defined and measured, and whether quality measures could be applied across a broad spectrum of health care providers.
ASCO is continuing to work with Congress and CMS, as well as colleagues in the cancer community to ensure that any quality programs are designed to enable physicians to provide quality care efficiently and effectively.
A number of pay-for-performance bills have been introduced in Congress already, and more are expected before the end of the year. We will continue to update you on developments as they move forward in Congress. Please contact ASCO’s Cancer Policy & Clinical Affairs Department at 703-299-1050 or publicpolicy@asco.org with any questions.
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A Review of ASCO’s Quality Care Initiatives
ASCO also provided the following information to the subcommittee about our quality-oriented agenda in research, practice initiatives, and the public policy arena:
National Initiative on Cancer Care Quality (NICCQ)
ASCO’s groundbreaking national study of 1,800 patients measured the degree to which breast cancer and colorectal cancer patients received care consistent with clinical practice guidelines. The study results, published earlier this year, found that adherence to accepted guidelines was quite high, in fact higher than found in previous quality studies of care for cancer and other chronic medical conditions. However, the study also suggested areas for potential improvement, medical record documentation among them.
Quality Oncology Practice Initiative (QOPI)
QOPI is ASCO’s nationwide initiative to promote excellence in cancer care by helping practices create a culture of self-examination and improvement. Twice a year, staff at participating practices conduct a retrospective review of patient charts. The QOPI system then generates a report for each practice, comparing individual practice results to the aggregate. Participating practices use QOPI data to inform performance improvement efforts.
In January, ASCO expanded participation in QOPI to its members nationwide, and now more than 150 practices, representing more than 1,000 oncologists, are enrolled. The American Board of Internal Medicine recognizes QOPI as the only oncology-specific measurement program approved for use in meeting its new practice performance requirements for maintaining board certification.
ASCO/NCCN Quality Measures
ASCO and NCCN collaborated earlier this year to select a subset of NICCQ measures that can be used to assess quality for breast and colorectal cancer care. These measures will be posted on both organizations’ websites later this summer.
Clinical Practice Guidelines
ASCO’s clinical practice guidelines are among the most rigorous in medicine. They address a wide range of clinical topics, focusing on treatments or procedures that impact patient outcomes, represent areas of clinical uncertainty or controversy, or are used inconsistently in practice.
Cancer Quality Alliance
Formed by ASCO and the National Coalition for Cancer Survivorship, the Cancer Quality Alliance is a forum for the variety of public- and private-sector entities across the cancer community, including physicians, nurses, patients, Medicare officials, accrediting organizations, and private payers, whose focus is on fostering quality measurement and cancer care quality improvement.
