Smarter radiation oncology.

Abstract

32 Background: The evolution of radiation oncology (RO) has established granular and detailed CPT codes that define the process of care for patients receiving radiation services. And while each of these codes are legitimately and carefully crafted within the relative value system, they nonetheless serve as surrogates for treatment. As health care moves into a value based future, RO is uniquely situated to offer high-value and affordable cancer care. In addition, ASTRO’s ‘safety is no accident’ and other authoritative articles show a high emphasis of structure, a ‘learning curve’ in process but a dearth of direction on outcomes. A truly integrated practice standard for RO has therefore not yet been realized. Methods: Over the last 5-yrs, based on learning from incidents reported in our department and a risk mitigation study, we have reshaped our practice to be based on three measurable aspects – evidence based and consensus driven care pathways, patient experience and quality. By assimilating the cost perspective into this three-tiered matrix, we believe we have created a model for RO that is predictive of value. We summarize facets of this model that embrace structure, process and outcomes aspects of quality that we believe add most value to the care we provide. Results: The elements of Smarter Radiation Oncology (SRO) were determined to be process mapping, standardization of treatment pathways and toxicity grading, incident reporting, pre-treatment peer review planning contour rounds, our no-fly policy, the Kaizen approach to overhead mitigation, an electronic whiteboard for process co-ordination, survivorship, patient perception of care and the Z-score for measuring operational efficiencies. Conclusions: SRO has shown a sustained and substantial level of improvement in many aspects of the care we provide. And while it is designed to allow for the unencumbered freedom to practice RO, we are often times limited by payers who refuse care based on the artificial and differential aspects of complex therapy. We plan to present how SRO improves value by offering less expensive care that can be used as a foundation for a new episodic payment system based on cost. If adopted, the decision process of therapy becomes agnostic of technology and patient focused.