Oncology Rounds

CMS proposes outcomes-based quality measure for outpatient cancer care

by Bryan Miller

For the first time, CMS is proposing to add an oncology measure to its Hospital Outpatient Quality Reporting (OQR) Program. The measure, OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy, is designed to assess the quality of care for chemotherapy patients and encourage performance improvement. If the proposal is finalized, the measure would impact hospitals’ outpatient Medicare payments, beginning in 2020.

Goal to reduce preventable ED visits and hospitalizations

The new measure focuses on cancer patients who receive hospital-based outpatient chemotherapy and who have an inpatient admission or ED visit within 30 days for one of ten conditions. The ten conditions are:

  • Anemia
  • Nausea
  • Dehydration
  • Neutropenia
  • Diarrhea
  • Pain
  • Emesis
  • Pneumonia
  • Fever
  • Sepsis

CMS is focusing on these ten conditions because the agency believes they are preventable causes of ED visits and hospitalizations. The measure excludes patients with leukemia.

Two scores determine the measure

The measure consists of two scores—one for inpatient admission rates and one for ED visit rates. The rates are determined by the hospital’s current and expected inpatient admissions and ED visits and national observed rates on inpatient admissions and ED visits. In addition, the rates will be risk-adjusted for factors such as patient demographics, cancer type, comorbidities, treatment type, and possibly sociodemographic status.

Though the measure recognizes two outcomes—inpatient admissions and ED visits—a single patient can only be assigned a single outcome. Thus, patients experiencing both an inpatient admission and an ED visit will only count as having an inpatient admission. Patients with multiple inpatient admissions during the measurement period will only count as having a single inpatient admission.

New measure is claims-based

Because the new measure is claims-based, it is unlikely to impose a significant data collection or reporting burden on providers. But the claims-based nature of the measure isn’t all good news. Most cancer programs don’t have access to data on admissions and ED visits and therefore have little visibility into their current performance on this measure. As a result, they may have trouble identifying and addressing any challenges before the program starts.

New measure looks at outcomes, not process

Unlike the 14 core medical oncology quality measures CMS and private insurers agreed to in February which are process-based, the newly proposed measure is outcome-based. It is similar in structure to the outcome-based measure CMS proposed for PPS-exempt cancer hospitals in this year’s Inpatient Prospective Payment System proposed Rule.

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