Presentation Transcript

1. QOPI – A Fellow’s Angle

   Matt Whitehurst, M.D. H. Lee Moffitt Cancer Center
2. Overview – QOPI Participation Why is this important Oncology Workforce State of Oncology Practice Quality in Cancer Care What is it QOPI Background Benefits Drawbacks The Process from a Fellows’ Viewpoint Critical Eye – Lessons Learned Impact / Implications
3. The Why (is it important) ASCO State of Cancer Care – 2014 Oncology Workforce State of Oncology Practice Quality in Cancer Care Oncology Workforce Projected shortages Geographic considerations Physician burnout Leveraging the workforce State of Oncology Practice Practice size increasing Financial instability General recommendations (to payers and lawmakers) Quality in Cancer Care Physician led quality initiatives Big data Quality monitoring and IT Establish a common understanding of how to define and measure quality
4. The Why#1: Oncology Workforce Oncology Workforce – From ASCO’s eyes Projected shortages Estimating that by 2025, demand growth 42% while supply of oncology services growth 28% May be shortage of >1487 oncologists Fueled by large number of anticipated retirements Geographic considerations Only 3% of oncologists based in rural areas, where 20% Americans live Physician burnout Leveraging the workforce Collaborate with PCPs and other cancer specialists Properly utilizing APPs Improve patient access
5. The Why#2: State of Oncology Practice State of Oncology Practice Practice size increasing Between 2012-2013, median # of physicians increased from 9 to 15 Largely due to consolidations/mergers rather than growth Financial instability Oncology had decline of 4% annual income from 2011 to 2012 Greatest threat facing Oncologists Many cutting back support staff Sending patients to hospital for chemotherapy General recommendations Payers should align payment systems with goal of delivering high-value care Reduce instability in federal payment systems Repealing the sustainable growth rate (SGR) Reversing cuts/changes that disproportionately harm small community practices Congress Enacts SGR Patch Posted March 31, 2014 ASCO Greatly Frustrated by Congressional Failure to Act on SGRDisappointing 12-Month "Patch" Throws Oncology Practices into One More Year of Instability
6. The Why#3: Quality in Cancer Care Quality in Cancer Care Physician led quality initiatives show potential! Big data Quality monitoring and IT Establish a common understanding of how to define and measure quality Others are already looking into “quality” measuring……
7. 4/2/14 “Consumer groups, insurers, employers and the news media have sought the information to help them evaluate clinicians.”
8. “Simply put, we ask if patients died or experienced a complication during their stay in the hospital for a range of common procedures and condition.”
9. “Read detailed reviews from members near you to find out which doctors to trust, and which to avoid.”
10. So What is QOPI? Quality Oncology Practice Initiative (QOPI) A quality improvement program for outpatient oncology practices consisting of retrospective chart reviews evaluating a variety of “measures” Developed by Oncologists, launched in 2006 QOPI's goal is to promote excellence in cancer care by helping practices create a culture of self-examination and improvement. Self-reported results. Preferentially selects recently-seen patients, all with invasive malignancy Chart requirements range from 48-100, depending on size and modules reported
11. Some Benefits of QOPI Relatively inexpensive Comparative results provided that show how practices compare to others For Trainees, participation satisfies ACGME requirements for practice based learning, analysis, and improvement CME credit ABIM maintenance of certification
12. The Process of QOPI (my perspective) 10 Charts per fellow The chart MRNs were given to us – it must have been tedious to search for qualified charts We then logged into the QOPI site and logged the measures while going through the charts. Alternatively, could have used pre-printed measure outlines to make the data entry somewhat faster We (fellows) investigated the “Core” and “Symptom /Toxicity Management” modules for our selected patients Other providers did “Care at End of Life”, “Breast Cancer”, “Colorectal Cancer”, “NSCLC” modules QOPI projects in the beginning each chart should take ~1 hr It wasn’t as long for me - maybe ~30 mins or less But we only did “Core” and “Symptom/Toxicity Management” modules
13. The Process and Things Learned Most measures are reasonable Some measures are even good Some measures……..aren’t so good Redundant Irrelevant
14. The Process and Lessons Learned Quality – at least on paper, we don’t know it when we see it “quality” of the physician is often not reflected in the notes Physicians themselves are rushed Fellows can be even more rushed We document poorly Maybe the fellow missed the “big picture” or “small but important details” Some attendings care less about notes than others Big points are often documented by RNs/assistants/pharmacists Pain scales, height/weight vitals, chemo doses, anti-emetics, emotional well-being, smoking status, etc… What about timeliness of the notes? Make sure those doing the chart review understand why Patients won’t care
15. With That Being Said….. In the near future, we will be graded on “quality” whether or not the definition is accurate or not We SHOULD use a system designed by Oncologists We need to control our own destiny It is the lesser of all evils We SHOULD report our successes to the community at large, but even more importantly…. We SHOULD report our successes to the powers-that-be
16. Closing Remarks We need all of the oncologists we can find (and keep) QOPI is a painful process Quality measures will be absolutely necessary in the near future for reimbursement We need ASCO and QOPI to succeed. QOPI needs us to build a Fighting Weight for implementation to payers as a viable quality metric system You may even identify deficiency areas in your practice Maybe QOPI will be less painful once we realize the implications
17. ASCO