National Comprehensive Cancer Network

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2013 NCCN Policy Summit: Measuring Quality in Oncology – Challenges and Opportunities

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Variations in the quality of cancer care are well documented. A key element of quality monitoring is standardized measures of care. Quality measures may include both process measures and outcome measures. Process measurement is only one aspect of assessing the quality of cancer care; measuring outcomes and providing the appropriate structure for care are also important. Measuring outcomes such as overall survival can be expensive and complicated by existing co-morbidities and may take too long to measure to truly affect delivery of care. Adherence to process measures is often used as a proxy for long-term survival. The implicit assumption is that adherence to good processes will predict good long-term outcomes. Quality measures can be used for both self-assessment and external review of the quality of care.

Payers and purchasers of health care are often users of standardized measures as they seek to ensure their beneficiaries are receiving high quality cancer care for a reasonable cost. Both public and private payers are placing a greater emphasis on quality, often times by linking reimbursement to quality. In response to this growing trend to prove value, payers, professional organizations, and provider groups have begun to create metrics based on evidence from research literature and guidelines. Quality measures that quantify the patient experience are also becoming increasingly popular, including but not limited to length of time away from work or family, speed and completeness of recovery, avoidance of toxicity and financial hardship are important to patients, but may or may not be used by providers or payers in their assessment of quality.

On Friday, July 12, 2013, the National Comprehensive Cancer Network® (NCCN®) held the NCCN Oncology Policy Summit: Measuring Quality in Oncology – Challenges and Opportunities at the National Press Club in Washington, DC. Stakeholders gathered to discuss the challenges and opportunities for measuring quality care in oncology. The Summit included discussion of current efforts to develop quality measures, the value of quality measures, and patient and caretaker perspectives of quality. The program, moderated by Clifford Goodman, PhD, the Lewin Group, consisted of short presentations and three panel discussions with audience participation.

After opening remarks from NCCN Chief Executive Officer, Robert Carlson, MD, three stakeholders gave brief presentations on their personal perspectives on quality in cancer care. The session, How I Define Quality, opened with Jennifer Malin, MD, PhD, Wellpoint, discussing what she does not consider part of quality care – too little care, the wrong care, too much care, and care that does not take into consideration the patient. Lillie D. Shockney, RN, BS, MAS, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, spoke next about a patient's perspective of what constitutes quality cancer care. Ms. Shockney highlighted the importance of patients having access to specialists and care teams with good communication skills, and specifically, care teams who support patient empowerment in decision-making and work to preserve the patient's quality of life. This session concluded with remarks from Samuel M. Silver, MD, PhD, the University of Michigan Comprehensive Cancer Center, who spoke about his experiences as a physician treating patients, as well as becoming a person diagnosed with cancer. Recounting a patient who had been referred to him for a second opinion, Dr. Silver emphasized that, in most cases, quality care is the right diagnosis and the right treatment in the right timeframe in the right environment.

The first roundtable of the day, Forging a Path to Quality, was moderated by Dr. Goodman and featured eight panelists with extensive knowledge around measuring quality in oncology. The panel was comprised of Stephen B. Edge, MD, Baptist Cancer Center; Kate Goodrich, MD, MHS, Centers for Medicare and Medicaid Services (CMS); Bruce J. Gould, MD, Northwest Georgia Oncology Centers; Clifford A. Hudis, MD, Memorial Sloan-Kettering Cancer Center; Karl Lorenz, MD, MS, Rand Health; Barbara L. McAneny, MD, New Mexico Oncology Hematology Consultants; Margaret E. O'Kane, MHA, National Committee on Quality Assurance; and John Sprandio, MD, Delaware County Memorial Hospital. Panelists discussed existing quality measurement programs and how they are being utilized. The group identified several areas where improvements are needed, including, but not limited to, collection of patient-reported outcomes, better measures to gauge the patient experience, more prospective quality measurement, and development of measures beyond the basic process measures.

The afternoon portion of the Summit commenced with the second roundtable, Perspectives of Quality after a Cancer Diagnosis, featuring Terry S. Langbaum, MAS, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Liz Scott, Alex's Lemonade Stand Foundation; Ms. Shockney; Dr. Silver; and Ellen Stovall, National Coalition for Cancer Survivorship. All panelists, who have had previous experience as either a patient or caregiver, discussed their individual experiences and what quality meant to them. Ms. Scott emphasized the importance of listening and communicating by all doctors, nurses, and staff with whom a patient and their family interacts. Panelists discussed how the overall culture of a hospital, or how a patient and his or her family is received, all contribute to defining a quality experience.  Based on their shared experiences, the panel unanimously agreed that improvements are needed in measuring the patient experience and sharing feedback back with the system to improve quality.

The Summit concluded with the third roundtable, Payer, Employer, and Industry Perspectives on Quality, which focused on public and private payer, employer, and industry viewpoints on quality and measuring quality. Panelists included Mary Bradley, Pitney Bowes, Inc.; Stephen Cha, MD, Center for Medicaid and CHIP Services; Kim Harrison, MHSA, Blue Cross Blue Shield of Michigan; Dr. Malin; W. Thomas Purcell, MD, MBA, University of Colorado Cancer Center; and Art Small, MD, Genentech. Part of the discussion focused on how payer-sponsored quality programs are tied to standard reimbursement models and new, innovative reimbursement models. Dr. Malin raised the issue of transparency in quality data and how the data can be used by patients to find the best doctors at the best prices. Dr. Cha also discussed the challenges a public program like Medicaid has in measuring quality and mentioned a significant challenge is uniform data. The panel concluded similarly to previous roundtable discussions during the Summit that significant opportunity exists for improvement in measuring quality care in oncology.

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If you have questions about NCCN Policy Summits, please contact Marisa Getzewich, Manager, Business Development.