Creating meaningful measurements for cancer care has been difficult.
Under President Barack Obama, the Centers for Medicare and Medicaid Services (CMS) worked towards transforming Medicare from a fee-for-service to an outcomes-based payment model. Outcomes-based reimbursement can provide physicians with incentives to focus on improving patient health, rather than prescribing tests, services, or drugs.
The Department of Health and Human Services intends to reduce fee-for-service payments 50% by 2018 through the increased use of alternative payment models, such as accountable care organizations (ACOs) and bundled payments. Specifically, CMS aimed their efforts at cancer care, since it accounts for a large portion of spending, but is not linked to survival outcomes, according to a viewpoint article published by JAMA Oncology.
Since alternative payment models are becoming more common among providers, challenges persist regarding outcomes measurements.
To determine meaningful outcomes, there must be a thoroughly tested approach for providers and healthcare systems to use, according to the article. Currently, there are numerous process measures, but few outcomes measures.
The study authors suggest that creating the optimal quality measurement is reliant on whether the patient values the outcome more than the way it was achieved, and that the measures contribute to outcomes and leave out staffing patterns, communication, infrastructure, and transitions of care.
Measuring meaningful patient outcomes have proven difficult, especially when it comes to cancer outcomes. A 1999 report outlined 10 recommendations to improve the quality of care, but these remained unused in 2014, according to the article. An analysis revealed that the only measures that were adopted typically dealt with end-of-life care.
To update the analysis, the authors compared quality measures for colorectal, breast, prostate, and lung cancers that were endorsed by numerous organizations, and tracked by major alternative payment models.
The investigators found that a majority of the measures included were process measures, and no alternative payment models planned to track outcomes measures.
However, the authors were not surprised by the results due to the varying nature of cancer. A specific outcomes measure can only be applied to a specific group of patients within a disease state.
Additionally, cancer care is complex, and the disease does not follow typical disease progression. Patients who are seeking palliative care for treatment-resistant disease would require alternative quality measures.
Creating expansive outcome measures is not impossible, but has been difficult. The International Consortium for Health Outcomes Measurement created cancer disease-specific standard outcome measures that place an emphasis on PROs, which was used to determine pain and nausea in alternative measures.
In the Oncology Care Model measurements, there are 13 components of the plan, which include goals, out-of-pocket costs, physician responsibilities, quality-of-life, and surveillance plans, according to the article.
While a care plan is not technically a measurement, it presents an opportunity for patient engagement, which adds value to the treatment. Adoption of the care plan in these measures allows for more rapid testing of outcomes measures in the future.
Now, an accelerated path towards validating cancer outcomes measures is needed. Measures for the most prevalent cancers in the United States, such as lung, breast, prostate, and colorectal, should be moved into testing.
Through the 2015 passage of MACRA, CMS is able to adopt experimental measures, which could lead to increased endorsement of certain measures. For value-based reimbursement to be successful, meaningful measurement of outcomes are necessary, and stakeholders should work together to create and test these measures, the article concluded.