An interview with Jordan Johnson, Director of Compliance, CruxQS during ASTRO in 2016.
Does safety effect the reimbursement model under MACRA?
Yes. Safe treatment equates to better outcomes. Reimbursement will be based on outcomes benchmarks. There will be an increased need to have the tools and solutions that improve quality and outcomes. This has not been proposed by CMS yet and is a monumental chore for them, however, Merit Based Incentive Payment System Clinical Practice Improvement Activities (CPIA) Performance Category: Patient Safety can be used to promote. Also, MIPS Quality Category comes to mind specifically outcome measure; Oncology: Radiation Dose Limits to Normal Tissues Percentage of patients, regardless of age, with a diagnosis of breast, rectal, pancreatic or lung cancer receiving 3D conformal radiation therapy who had documentation in medical record that radiation dose limits to normal tissues were established prior to the initiation of a course of 3D conformal radiation for a minimum of two tissues.
How does this shift to quality change treatment protocols?
This shift will indicate shorter fractionation protocols and SRS and SBRT. With thee fractionation regimens dose per fraction will increase, which also increases the risk. This increase in risk promotes the need for mechanisms to ensure quality and safety.
Does quality impact a department’s or facilities legal risk?
One of the biggest costs to healthcare system is litigation, which impacts quality scores. CMS is becoming more transparent with quality scores as they allow healthcare system to be compared. This visibility allows patients to choose where they receive their care. Just as technology frequently changes so should the methods to ensure that this technology is performing as planned and safely to avoid potential litigation and deceased quality scores. This is the case beginning in 2017 with the MIPS CPIA Category. As it comes into play here with the activity: Measure and improve quality at the practice and panel level that could include one or more of the following: Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level.
How have current reimbursement models impacted department and facility cost reduction and initiatives? How do those initiatives impact safety and quality?
Decreased overall reimbursement have caused radiation oncology departments to push productivity and efficiency models. The largest non-fixed expense in the department is staff. Though efficiency must be increase quality must not be sacrificed. This product does not look at data retrospectively but in real time and for each fraction treated. Demands for ensuring quality greatly increase as staffing models are implemented. Again, the 2017 Advanced APM initiative focuses on this and will continue to be very important.