Challenges of diagnostic concordance of lung cancer cases in Qualified Clinical Data Registry (QCDR) measure collection by CMS in calculating MACRA's rewards and penalties.

Abstract

6604 Background: QCDR was introduced for the Physician Quality Reporting System (PQRS) beginning in 2014. A QCDR is a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care provided to patients. Those who satisfactorily participate in PQRS through a QCDR may avoid the 2018 negative payment adjustment -2.0% of total Medicare payments. PQRS #396 is an example of a measurement by which oncologists may be evaluated. A physician’s QCDR score is determined by his/her numerator and denominator per patient based on total data submitted by various healthcare providers. Methods: IRB approval was obtained for a retrospective review of 60 randomly selected NSCLC pathology reports that were diagnosed at UTMB. The Denominator was determined by CMS to be: The patients were between the ages of 18-75; the diagnosis of NSCLC was coded by the appropriate ICD and CPT codes. The Numerator was determined by CMS to be: Pathology reports with a diagnosis that included pT pN for NSCLC with histologic type vs those not documented for medical reasons vs those specimens that were not of lung origin, or were classified as NSCLC-NOS. Results: The study consisted of 60 NSCLC pathology reports of which 2 were determined in retrospect not to have been lung cancer cases. Another 10 were considered to be incomplete. A final 2 were diagnosed as a different histological lung cancer type. As [60 - (2+10+2)]/60 = 76.67%, adherence to the quality standard was less than perfect even though excellent medical care was delivered. This score puts the institution at risk of a 2% Medicare Payment Reduction in 2018 if a majority of other institutions score even slightly higher. Conclusions: Physician remuneration will be reduced by current information submitted to CMS. As the quality scores will be made public, reputations may be negatively impacted. Coding and billing operations may be hindered in their attempt to accurately submit data to CMS. Healthcare Systems may be less inclined to request outside consults (including NGS) that may provide a different diagnosis that could confuse the QCDR.