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.