The impact of value-based payment on the referral of oncology patients to tobacco cessation services.

Abstract

116 Background: The purpose of this study is to investigate the relationship between the introduction of value-based payment, the initiation of a quality improvement project, and practices’ performance to refer or administer tobacco cessation counseling to patients. Methods: The Michigan Oncology Quality Consortium (MOQC) is a statewide quality collaborative sponsored by Blue Cross/Blue Shield of Michigan (BCBSM). MOQC uses ASCO's Quality Oncology Practice Initiative (QOPI) for measurement.Value-based payment (VBP) was introduced in 2017 by BCBSM. The VBP is achieved if a region reaches a target established for four QOPI measures. One of the four quality measures is QOPI's core measure 22bb: tobacco cessation counseling administered or patient referred. At the time the VBP was introduced, a subset of MOQC practices chose to initiate a quality project to improve performance on this measure. Analyses describes the performance of all MOQC practices with the introduction of the VBP, and performance of the practices who chose to revise their tobacco cessation processes to address performance. Results: The proportion of patients who were administered or referred to tobacco cessation services in participating MOQC practices was 49% (n = 793 charts) from abstracted rounds Spring 2014 - 2017. After the introduction of VBP, this proportion increased to 58% (n = 307 charts) in Fall 2017. Performance improved on this QOPI measure for both subsets of MOQC practices - those practices that chose to initiate a quality project focused on this measure (n = 19) and practices that selected another measure (n = 27). Practices that developed a quality project improved their aggregate proportion from 46% (Spring 2014-2017, n = 839 charts) to 51% (Fall 2017, n = 266 charts). Practices that focused on another quality measure improved from 51% (Spring 2014-2017, n = 789 charts) to 65% (Fall 2017, n = 265 charts). Conclusions: Our data suggest that the presence of VBP may have had a positive impact on referral patterns for tobacco cessation services for cancer patients. Additional analyses are required to determine if there is a combination or sequencing of VBP and process improvement strategies to optimize the delivery of quality care.