How do you measure the quality of care patients with cancer receive? How long they live? Avoiding side effects? Patient satisfaction? Process measures?
Further, there are multiple types of cancer and different cancer have different recommended treatments and methods of providing care. To further complicate the issue, new cancer treatments are being introduced in rapid succession; what qualifies as high quality cancer treatment today may be out of date months or even weeks later.
So what are the options? Provide uber-detailed qualty metrics for each individual tumor type (or even within tumor type)? Measure quality of care broadly? Or give up on the whole top-down quality measurement endeavor.
A recent paper by Valuck et al. (2017) examined current quality measures and practice guidelines for 10 tumor types:breast, chronic myelogenous leukemia (CML), colon, kidney, melanoma, non-Hodgkin’s lymphoma (NHL), non-small cell lung (NSCLC), ovarian, pancreatic, and prostate. Then, they asked a panel of experts how these quality measures should best implemented in practice.
The group determined that overreliance on condition-specific process measures is problematic because of rapidly changing evidence and increasing personalization of cancer care. The group’s primary recommendation for enhancing measure sets was to prioritize and develop effective cross-cutting measures that assess clinical and patient-reported outcomes, including shared decision making, care planning, and symptom control. The group also prioritized certain safety and structural measures to complement condition-specific process measures.
They also come to some sensible recommendations:
VBP models should leverage the best available measures, beginning with those identified by the CQMC, as well as monitor adherence to pathways and incentivize PRO data reporting.
Payers and providers should use a layered measurement approach for performance improvement, monitoring, and accountability measures, aligned across the physician, system, and external accountability levels.
Measure developers (e.g., ASCO, ASTRO, and NCQA); program implementers (e.g., CMS, state Medicaid agencies, Medicaid managed care organizations, and commercial health plans); and industry should continue to support, fund, and develop cross-cutting measures, including clinical outcomes and PRO-PMs, leveraging collaborative processes such as the NQF Incubator.
Public- and private-sector payers, measure developers, and industry should incorporate best practices to improve measure specifications, evaluate the impact of measures used in accountable care programs, and address measurement methodological issues in model design and measurement (e.g., risk adjustment and stratification and provider attribution), as identified by groups such as HCP LAN and NQF.
Research organizations, such as the Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute, and industry should fund measurement science, including PRO-PM design and implementation.
Overall, an interesting perspective on measuring and paying for quality.
- Valuck, Tom, David Blaisdell, Donna P. Dugan, Kimberly Westrich, Robert W. Dubois, Robert S. Miller, and Mark McClellan. “Improving Oncology Quality Measurement in Accountable Care: Filling Gaps with Cross-Cutting Measures.” Journal of Managed Care & Specialty Pharmacy 23, no. 2 (2017): 174-181.
- Levit LA, Balogh EP, Nass SJ, Ganz PA, eds. Delivering High-Quality Cancer Care: Charting A New Course for a System in Crisis Report. Washington, DC: National Academies Press; 2013. Available at: http://nationalacademies.org/hmd/reports/2013/delivering-high-quality-cancer-care-charting-a-new-course-for-a-system-in-crisis.aspx.
- National Quality Forum. Cancer measure set: value-based episodes of care.
- National Quality Forum. Cancer care phase I-II.
- National Quality Forum. Cancer 2015-2017. http://www.qualityforum.org/Cancer_Project_2015-2017.aspx. Accessed December 27, 2016. 10. Centers for Medicare & Medicaid Services. Consensus core set: medical oncology measures, version 1.0. Updated November 23, 2015. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/Medical-Oncology-Measures.pdf.