Lessons learned from a cancer center-specific federal quality reporting program.

Abstract

42 Background: As part of the Affordable Care Act (ACA) of 2010, the Prospective Payment System-Exempt Cancer Hospital Quality Reporting (PCHQR) Program was created for 11 cancer centers. PCHQR includes an initial set of 5 measures mandated for federal reporting and expanded to include 18 measures for subsequent program years. The Alliance of Dedicated Cancer Centers (ADCC) formed in 1983 to include and represent the interests of the same 11 centers. As a small and previously organized group, we have been able to collaborate closely throughout implementation of PCHQR to understand, evaluate, and offer feedback on the program. Methods: The ADCC began sharing and reviewing data on mandated measures upon the release of the ACA in 2010. Numerator and denominator data for measures are manually uploaded from each center to a common master file bi-annually. In December 2013, ADCC hospitals formally began sharing feedback on concordant and non-concordant cases through email, bi-annual in person meetings, and monthly teleconferences. Results: Through sharing feedback on data submission with each other, CMS, and CMS contractors the ADCC learned the following lessons: 1- Limitations exist in the submission of our current data sets, (e.g. inability to accurately capture all scenarios that lead to appropriate delays in treatment). 2- Process of care measures are topped out with aggregated values above 95% for multiple consecutive quarters. 3- 4 of the existing measures and multiple forthcoming measures have case selection criteria creating sample sizes of little comparative value or statistical significance. 4- Tertiary care centers share many unique treatment patterns affecting compliance (e.g. lag time from referral to diagnosis, high percentage of patients on clinical trials). 5- Subject matter experts embedded at the 11 centers are critical for measure development/ refinement (e.g. Tumor Registrars, ICP’s). 6- CMS, CMS contractors, and affected hospitals must establish effective communication channels. Conclusions: Our early experiences indicate it is challenging to apply broad national measures to the ADCC hospitals. The 11 centers seek to continually improve upon this mandate and advance clinical practices.