By David Beyer, MD, FASTRO, ASTRO Past Chair
It’s not a surprise to hear that specialists struggle with federal quality reporting. The Merit-based Incentive Payment System (MIPS), which I report to, combines many previous programs, like the Physician Quality Reporting System (PQRS) and Meaningful Use (MU). Even in the previous programs, it was difficult for specialists like radiation oncologists to find and report on meaningful and relevant measures. This issue persists in the current program.
As a radiation oncologist in small private practice without the added support of a practice administrator or other staff, it is a challenge for me to comply with these federal requirements. In 2017, when I was required to report to MIPS to avoid the four percent penalty, I chose the Quality Oncology Practice Initiative (QOPI®) Reporting Registry as my data collection and reporting tool. Many larger practices already utilize sophisticated reporting tools like QOPI to ease the burden of reporting. However, as many of us know, the burden is acutely felt at the small and solo practice level and I wanted to share my own experience with this tool for others in similar practice settings.
QOPI, developed by ASTRO and the American Society of Clinical Oncology (ASCO), is a Qualified Clinical Data Registry (QCDR) approved by the Center for Medicare and Medicaid Services (CMS). QOPI, an Electronic Health Record (EHR)-agnostic system, enables practices to aggregate data, monitor performance over time, compare to benchmark data and identify areas for improvement — all while satisfying federal reporting requirements.
There are two data collection options for practices, and I have now used both. As a solo practice, I was worried about the technical requirements of the QCDR so in 2017 I opted for the Web Interface Tool, the manual data entry option. This was straight forward and I was able to complete data entry and submit it fairly easily. It just required the time to manually input all the patient data I wanted to report. In 2018, I knew that I had to report more data on more patients and opted for the System Integration collection option. The first, and most frustrating challenge, was getting my hospital to sign all the necessary legal documents. But once I signed up for QOPI, the vendor, FIGmd, took charge and let me know what I needed to do. They set up the links and started to pull data from my ARIA® oncology information system (OIS), directly into the QCDR. No additional modules were needed. But this is where I lived the truism that every OIS or EHR instillation is unique and mapping the data for each selected quality measure took some time. FIGmd set up calls, always according to my schedule and that of my hospital information technology expert, who is sometimes critical, to find the data. The work is iterative, but they were very easy to work with and provided direct assistance with compiling the data needed for quality reporting.
QOPI, however, is not just a data collection and reporting tool. The idea behind a QCDR is that specialists, who know their field the best, should be the ones to develop relevant quality measures. As a QCDR, QOPI can and has created additional quality measures not currently available in MIPS. This offers more flexibility than other reporting tools. In 2019, QOPI has 34 measures, 23 of which are reportable by radiation oncology practices. While each one might not fit my practice, there are many that are meaningful to my practice.
MIPS continues to change and evolve. Medicare payment adjustments are based on how practices participate during the reporting year, as well as how they compare to other reporting practices. In 2019, physicians must achieve at least 30 points to avoid a seven percent penalty in 2021. As the requirements get harder, the solution needs to be easier, especially for small practices. For me, the answer is QOPI Reporting Registry.
Registration is limited to practices with at least one active ASTRO or ASCO member. There is a cost of $495 per physician to submit data to CMS via the System Integration function and $295 for the Web Interface Tool functionality. For questions about the QOPI Reporting Registry, email ASTRO's QCDR team.
Posted: March 26, 2019
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By Dr. Paul Harari, MD, FASTRO, ASTRO Board Chair
March 15 was Match Day, and medical students across the country opened envelopes to learn which medical center and specialty they matched with for their residency training. For the first time in many years, there was a gap in the number of matches for radiation oncology with 29 slots going unfilled.
So why was there a gap in RO this year? Some believe this reflects an anticipated oversupply of radiation oncologists for the future. This concern appears to depend largely on geography, where some markets are showing limited job options and some markets much broader options. Some believe that these unmatched slots signal a concerning decline in the field. Others view the 2019 match as a simple market correction. Many have asked, what could, or should ASTRO or others have done to prevent this? It is important to note that there is no single oversight entity that controls the number of residency slots in a field, and anti-trust laws prohibit organizations such as ASTRO from engaging in activities that could negatively impact the U.S. free marketplace.
There were several preview signs that the specialty could experience this type of Match Day with several factors at play. As a first step, it may be valuable to review the overall resident training and oversight ecosystem. Each player has an integral role in the health of a system that trains a medical student to provide specialized care as a licensed physician.
Association of American Medical Colleges (AAMC): The not-for-profit association whose members include medical schools and teaching hospitals. They help students navigate the journey from pre-med through residency. Because their members include all the accredited medical schools, they manage the national residency matching program (NRMP) which occurred last week. They frequently advocate for federal funding for graduate medical education.
Medicare Program and Graduate Medical Education: In addition to setting the reimbursement rates it will pay for services for Medicare beneficiaries, Medicare recognizes that hospitals who train residents incur real and significant costs beyond those customarily associated with providing patient care. The Medicare program makes payments to teaching hospitals for a portion of these added costs through direct graduate medical education (DGME) payments. The DGME payment compensates teaching hospitals for "Medicare's share" of the costs directly related to the training of residents.
Accreditation Council for Graduate Medical Education (ACGME): The ACGME is an independent, not-for-profit, physician-led organization that sets and monitors the professional educational standards for residency programs. The ACMGE is responsible for defining the residency requirements for each specialty and has review committees for each specialty and fellowship area. The ACGME also has a process to evaluate, improve, and publicly recognize institutions and programs in GME that are in substantial compliance with standards of educational quality established by the ACGME. Lastly, the ACGME manages the case report system residents use to demonstrate progress toward requirements outlined in the residency requirements.
Teaching Hospitals: While Medicare controls how much it will pay per resident to a teaching hospital, a hospital may use its own money to fund additional residents. Each individual hospital decides if it would like to dedicate any of its own funds for this purpose and if so, how much and on which areas it would like to expand its training programs. Thus, the total number of residency slots in any specialty in a year is the sum of each individual teaching hospital’s decision about how many slots it will offer.
While GME funding has been flat since 1997, the number of radiation oncology programs and the number of residency slots has grown over the last decade. As you can see in this chart, both the number of programs and the number of slots offered by programs has expanded over the last decade.
Radiation Oncology Residency: 2006-2018 trends
Source: ACGME Data Resource Books
Upon completion of residency training, physicians then prepare for board examinations. In radiation oncology, the American Board of Radiology is the board which designs and tests individuals as to their competency in the practice of radiation oncology. They require individuals to pass three examinations to receive board certification: clinical, (radio)biology and medical physics. Boards also have various requirements to maintain certification that physicians must meet defined by the American Board of Medical Specialties.
Once a medical student or resident identifies their preferred specialty, they often join an affiliated specialty society to begin networking and become a member of the community. ASTRO is the membership organization with members defined as board certified radiation oncologists and medical physicists. ASTRO's role is to provide leadership to help guide the specialty into the future. ASTRO is dedicated to improving patient care and our core priorities including continuing professional education and training and the advancement of quality improvement, science and advocacy.
With regard to the workforce of radiation oncologists, ASTRO regularly studies and identifies trends through surveys and research. ASTRO's scientific journals also publish studies done by others about our workforce, including this 2016 study that predicted that current training program numbers could lead to an oversupply. These forecasts use predominantly historic information and often fail to capture how new scientific discovery and innovation might create new possibilities for the field. Still, it is important that these forecasts be available for medical students so that as they consider their future, they can make informed decisions about which field(s) they wish to pursue.
ASTRO can and does advocate for the modernization of training requirements to prepare radiation oncologists for the future. We anticipate that the ACGME will soon release a proposal to update the radiation oncology residency program requirements, and we will use this as an opportunity to comment with an eye toward the future health and growth of the specialty.
A 2019 ASTRO survey identifies that practicing radiation oncologists are most passionate about patient care interactions and being able to participate in the cure of cancer. Radiation oncology remains a critical modality of cancer treatment for patients around the world. The 2019 Match Day results will trigger highly welcome discourse about the specialty and the residency training landscape. ASTRO will do everything we can to help facilitate discussion and the sharing of accurate information.
Posted: March 20, 2019
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By: Ksenija Kujundzic, Quality Improvement Manager
Patient Safety Awareness WeekTM (PSAW), sponsored by the Institute for Healthcare Improvement, is March 10-16, 2019. It is a time to celebrate the numerous quality and safety initiatives already taking place and identify what more can be done to improve patient safety.
On any given day within a radiation oncology practice, radiation therapists perform time-outs, dosimetrists develop safe treatment plans, medical physicists conduct quality assurance tests on machines and radiation oncologists discuss patient cases during peer review meetings. Together as a clinical team, radiation oncology professionals commit themselves to safety every day. During PSAW, we celebrate this commitment.
How can you join ASTRO as we celebrate PSAW?
Express Your Commitment to Patient Safety on Social Media.
In honor of PSAW, ASTRO invites clinicians, practices, patient advocacy groups and more, to join us for our #SafetyIsOurPriority campaign!
Similar to the recent #WomenWhoCurie social media campaign, we encourage everyone to take a picture of you and/or your staff taking an oath to make patient safety a priority, and post to social media with the hashtags #SafetyIsOurPriority and #PSAW19! You can use our custom-made hashtag sign, which can be printed here.
Join RO-ILS and/or Report Safety Events.
RO-ILS: Radiation Oncology Incident Learning System® is an online safety data collection instrument tied with a federally listed patient safety organization.
Have questions about RO-ILS? Join our “Ask Me Anything” (AMA) event on ASTRO’s online community, ROhub. The AMA event takes place solely online. RO-ILS staff will be available on Tuesday, March 12 to answer any questions relating to the program. Questions can be posted on the ROhub thread between now and March 12 and will be answered during the online event.
Already enrolled in RO-ILS? Highlight to staff the importance of reporting all safety events, including incidents, near misses, unsafe conditions and operational/process improvement into RO-ILS. Analyze your practice’s data utilizing the Analysis Wizard within the RO-ILS portal. Celebrate safety interventions implemented in the past year.
Complete an application for ASTRO’s Accreditation Program for Excellence (APEx) by March 31 and receive $1,500 off! Contact APEx staff at firstname.lastname@example.org to register for the discount.
The APEx process is predicated on a self-assessment, which provides practices the opportunity to confidentially self-study, compare standards and implement quality improvement initiatives. This process allows practices to increase high-quality patient care as well as hold a more productive APEx facility visit. It is a method that offers data that stimulates curiosity and learning, making the accreditation process educational, rather than punitive. Facilities accredited by APEx are recognized as having demonstrated a commitment to providing safe, high-quality care to patients.
Read “Safety is No Accident”.
An updated copy of “Safety is No Accident: A Framework for Quality Radiation Oncology and Care” will be released on Wednesday, March 13 on the ASTRO website. Safety is No Accident, a key component of ASTRO's patient safety initiative, Target Safely, was last updated in 2012. Since then, ASTRO launched RO-ILS and APEx, new technology has emerged and numerous societal recommendations were published.
Engage Colleagues and the Radiation Oncology Community.
Highlight PSAW during your internal staff meetings and celebrate your ongoing safety activities. Discuss case studies and themes highlighted in RO-ILS education. Could a similar event occur at your practice? Why or why not? Celebrate staff for going above and beyond or for catching a potential safety event before it reached the patient. Thank staff for entering events into an incident learning system. On a national level, contribute to discussion threads in ROhub's Open Forum related to patient safety.
Discuss Safety with Patients.
Some patients worry about the safety of radiation therapy. Radiation has been used successfully to treat patients for more than 100 years. In that time, many advances have been made to ensure that radiation therapy is safe and effective. Share ASTRO's RTAnswers.org resources with patients, which include disease site-specific resources and a video and handout with questions for patients to ask their doctor about radiation therapy.
Review Scientific Literature on Patient Safety.
Practical Radiation Oncology (PRO), ASTRO’s official clinical practice journal, is dedicated to improving the quality of radiation oncology practice, documenting the state of current practice, providing background for those in training and the continuing education of practitioners. Patient safety is one of the key focus areas of PRO. The latest edition of PRO includes an ASTRO consensus paper on Standardizing Normal Tissue Contouring for Radiation Therapy Treatment Planning. Previous editions have published articles on safety culture, incident learning and ASTRO white papers, including one on Standardizing Dose Prescriptions.
Add to the body of scientific literature on patient safety by conducting research and submitting original articles to PRO. Additionally, implement recommendations published in PRO, the Red Journal, Advances and other scientific journals.
There are many ways you can improve patient safety during PSAW and throughout the year. ASTRO encourages every practice and every member of the radiation oncology team to make safety a priority every day. Comment below with how you or your practice celebrate patient safety.
Posted: March 5, 2019
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