Stephen S. Grubbs, MD Vice President, Clinical Affairs, ASCO

Transcription

1 Stephen S. Grubbs, MD Vice President, Clinical Affairs, ASCO Dr. Grubbs joined the Clinical Affairs Department of The American Society of Clinical Oncology (ASC0) in July 2015 after 31 years as a practicing medical oncologist in Newark, Delaware at the Helen F. Graham Cancer Center. He served as managing partner of his independent medical practice, Medical Oncology Hematology Consultants, PA. He is a chemical engineering graduate of Purdue University and graduate of the Thomas Jefferson University Medical School. Medical postgraduate training in Internal Medicine was completed at the Medical Center of Delaware and Hematology and Oncology at the Dartmouth Hitchcock Medical Center. He served as the Principal Investigator of the Delaware Christiana Care NCORP and Board member of the NCI sponsored Alliance cooperative research group. He remains a member of the Alliance Foundation Board and executive committee. He is a member of the state of Delaware Cancer Consortium Council and is chair of the Early Detection and Prevention Committee. He is a past member of the ASCO Board of Directors as well as the Ethics, Finance, Research, and Government Affairs Committees. Dr. Grubbs is a Clinical Assistant Professor of Medicine of the Thomas Jefferson Medical School faculty. He has served as a member of the National Cancer Institute Clinical Trials Advisory Committee, co- chair of the Clinical Trials Subcommittee of the NCI Community Cancer Centers Program (NCCCP), and the IOM Committee on Cancer Clinical Trials and the NCI Cooperative Group Program. He has been an active community based clinical trial investigator with the NCI sponsored CALGB, ECOG, NSABP, and Alliance Cooperative Groups since 1984 and is the recipient of the 2007 Association of Community Cancer Centers David King Community Clinical Scientist Award.

2 ASCO Clinical Affairs Department Washington State Medical Society April 22, 2016 Stephen S. Grubbs, MD Vice President Clinical Affairs

3 ASCO Clinical Affairs Department Helping practices survive and thrive today AND in the future Approved by the Board in 2014 to provide direct support and services to oncology practices In response to Rapid escalation in scope of practice issues Increasingly volatile practice environment Economic pressures Consolidations and mergers Focus on value New care delivery and payment models Growing administrative burden MACRA legislation

4 Resources for Practices Hands on help Practice efficiency Staffing models/work flow Quality reporting QI training and projects Learning networks Billing and coding reimbursement support Information and analysis Practice trends Economic analysis Performance measurement Payment reform

5 Clinical Affairs Divisions Analysis and Consulting Practice Management Performance and Quality

6 Analysis and Consulting Services Division PracticeNET Practice trends and forecasting Practice management forums MACRA education Clinical Affairs Data Warehouse and analysis Payment reform modeling Direct consulting services

7 A rapid learning network for oncology practice knowledge benchmarking, standards and best practices Initial focus on administrative, operational, financial and quality improvement activities For practices in all practice settings Peer to peer interactive collaboration for knowledge sharing Reports: Quarterly benchmarks produced by practice and by physician, compared against a national database of similar practices Annual state of your practice assessment for key production and cost measurements Our vision is for PracticeNET to become the largest oncology practice collaborative of its kind, allowing greater opportunities for sharing, assessment, reporting, and identifying practice trends and patterns

8 Weighted average among Practice physicians for established patient office visits ( ) 3.90 Weighted avg among Practice (practice data) Practice physicians

9 % deviation of all physicians at Practice, established patient office visits ( ) 8% % deviation among Practice (practice data) 6% 4% 2% 0% -2% -4% -6% -8% Practice physicians

10 SAMPLE REPORT: How busy are your physicians? wrvu HemOnc E&M at 80th %ile wrvu HemOnc E&M Only/FTE HemOnc Hospital Est. Pt. Visit/STD HemOnc Office Est. Pt Visit/STD HemOnc New Patients Hospital/STD HemOnc New Patients Office/STD HemOnc -150% -100% -50% 0% 50% 100% 150% % Deviation from PracticeNET Average NOTE: This is sample data for illustrative purposes only.

11 Collected Drug Revenue Q3/2015 $750, $745, $740, $735, $730, $725, $720, $715, $710, $705, $700, Drug cost on Q3/2015 (practice data) $695, Practice Collected Amount Total ASP

12 Collected Drug Revenue Q4/2015 $580, Drug cost on Q4/2015 (practice data) $560, $540, $520, $500, $480, $460, Practice Collected Amount Total ASP

13 Net Drug Revenue Q3 and Q4 6% % gain or loss compared to ASP 4% 2% 0% -2% Q3 Q4-4% -6% -8% -10% -12% -14%

14 Networking opportunities Peer to peer meetings Agenda driven by practice needs First meeting, spring 2016 Moderated listserv Enrollment is open! First practices have enrolled and are submitting data For more information. or

15 Clinical Affairs Data Warehouse A new data resource to support the work of Clinical Affairs, Policy & Advocacy, and other ASCO departments and initiatives Publicly available data from CMS Medicare provider Utilization and Payment Data: Physician and Other Supplier Public Use File, CY 2012 and 2013; Medicare Provider Utilization and Payment Data: Part D Prescriber for CY2013 Physician Compare Current Procedural Terminology (CPT) codes Relative value units Data from practices participating in PracticeNET Additional information: surveys; data from analytical work performed by ASCO when use is authorized Data aggregation processes allow analysis across disparate data sources

16 What is a PUF? Public Use File There are lots of them now and new ones are being produced by CMS at a steady pace. The ones we are using are the Physician and Other Supplier PUF for part B and D; and Physician Compare Physician and Other Supplier PUF, Part B Data include utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service for calendar years 2012 and 2013 and contains 100% final-action physician/supplier Part B noninstitutional line items for the Medicare fee-for-service population.

17 What s in the Medicare PUF? NPI National Provider Identifier Provider last name Provider first name Provider street address Provider city Provider zip Provider state Place of service HCPCS code HCPCS description HCPCS drug indicator Line srvc cnt Bene unique cnt Bene day srvc cnt Avg Med allowed amt Avg submitted chrg amt Avg Medicare pmt amt

18 What s in Physician Compare that can be linked to the PUF? NPI PAC ID Professional Enrollment ID Gender Medical credential Medical school name Graduation year Primary specialty First - fourth secondary medical specialties Organization legal name Organization DBA name Practice PAC ID Number of Group Street Address Group Practice City Group Practice Zip Code Group Practice Participating in erx Participating in PQRS Participating in EHR Received PQRS Maintenance of Certification Program Incentive

19 And why are we talking about it? Because these data are public, complete, and very detailed. Others will misunderstand and/or misrepresent conclusions that are reached and preached from these data. This gives you the opportunity to see how you compare to the population of oncologists.

20 ASCO Provider Utilization File: The ASCO PUF Medicare Physician and Other Supplier Public Use File, Part B Medicare Physician and Other Supplier Public Use File, Part D Medicare Physician Compare Work Relative Value Units

21 Weighted average for established patient office visits ( ) 4.5 Weighted Average GA RI MS PR SC LA IN VA AR ME TN HI NV IA KY OK DE MO FL WV MT CT KS NJ NY ID GU NE AL AK Society OR NM NC SD WY OH WI CO DC IL CA TX NH PA MD AZ MI UT VI WA ND MA VT MN

22 % deviation among Society practices, established patient office visits ( ) 30% 25% 20% 15% % deviation among Society practices % deviation 10% 5% 0% -5% -10% -15% -20% Society Practices

23 Medicare PUF Beneficiary service count per physician, established patient office visits ( ) Medicare beneficiary services/physician Beneficiary service count PR MN DC VI GU OR AK MA PA RI NY VT UT WA CO NM HI OH WI ME TX ND MI CA ID WY NH MD CT AZ NC IL MO KS OK LA NV MT KY NJ TN WV GA NE SD IN FL IA VA DE AL Society SC MS AR

24 Practice Management Division Clinical Practice Committee and work groups Patient Centered Oncology Payment (PCOP) model evolution and implementation Billing and Coding hot line Oncology Practice Insider e-newsletter FDA Alerts Medicare and commercial payer forums Support ASCO representatives to CPT & RUC committees and AMA HOD Member of AMA Advanced payment Model Work Group

25 Clinical Affairs Department Volunteers Clinical Practice Committee Practice Administrators Workgroup PCOP Implementation Workgroup Data Review Workgroup Physician Compensation Workgroup Coding, Reimbursement, and Billing Workgroup Quality QOPI Certification Oversight Council Quality Training Program Faculty Workgroup Niarchos Grant Steering Group

26 Developed by ASCO volunteers and consultants and published May, 2015 Multiple meetings and phone calls with practices and payers Educational webinars with payers, practices, practice managers and meetings with payers and practices ASCO is prepared to perform data modelling Claims data (payer) and Clinical data (practice EMR) Developing and acquiring tools to prepare practices to be successful in Alternative Payment Models

27 A Continuum for Practice Transformation Level 2 Level 3 Level 1

28 PCOP Level One Model $1,200 $1,000 Care Mgt Care Mgt Care Mgt Care Mgt Care Mgt $800 $600 $400 New Patient Infusion Infusion Infusion Infusion Infusion $200 $0 E&M E&M E&M E&M E&M E&M CM E&M E&M CM CM EM CM CM EM CM CM EM EM TREATMENT MONTHS ACTIVE MONITORING

29 Practice Related Activities Practice Administrators CPC Work Group expansion Expanded ASCO Membership AMA activities: Support CPT meetings and CPT Advisory Committee, RUC meeting and RUC Advisory Committee, House of Delegates Annual meetings: Carrier Advisory Committee (with ASH); Provider Payer Initiative Billing and Coding Reimbursement Service

30 Oncology Practice Insider (OPI) A free e-newsletter devoted to oncology practice management Updates on Medicare initiatives, Medicare coverage information, FDA drug alerts, legislative activities, coding and billing and more Redesigned and relaunching Over 600 subscribers and expanding audience Subscribe to OPI by ing practice@asco.org

31 Performance and Quality Division QOPI Certification Program (QCP) Quality Training Program (QTP) Quality Improvement grant management Niarchos Grant

32 QOPI CERTIFICATION The primary goal of the program is to improve care provided to patients with cancer and to recognize those practices that provide quality oncology care. An oncologist-led program defining cancer quality standards and provides the designation of quality care based on published performance measures and site standards. Copyright Your Practice Name has been recognized by the Quality Oncology Practice Initiative (QOPI ) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO). 15 American Society of Clinical Oncology. All rights reserved. Copyright 2016 American Society of Clinical Oncology. All rights reserved. 31

33 Certification Process Attain Benchmark Practice Submits Application Practice Submits Documentation On Site Review Practices submit Attests to Three Structured on-site data for 26 compliance randomly audits are Certification with 20 selected charts conducted by measures via chemotherapy for certified oncology pathway safety concordance nurses Must meet standards audit of QOPI Exit interview with scoring Payment chart practice thresholds abstraction leadership Overall quality Policies related outlines findings score: 75% to 3 of the Written report that certification has been standards reviewed by committee member Copyright 2016 American Society of Clinical Oncology. All rights reserved.

34 Certification Standards Consistent expectations for patient safety across diverse settings providing chemotherapy A framework for best practices in cancer care Encourages a review and update practice policies and procedures Encourages internal quality assessment Encourages external quality monitoring Copyright 2016 American Society of Clinical Oncology. All rights reserved.

35 QOPI Cer)fica)on Program Growth 525 Applicant Prac)ces 298 Cer)fied prac)ces 336 New Applicants 189 Recer)fying Represen)ng 3,826 Oncologists Copyright 2015 American Society of Clinical Oncology. All rights reserved. 34

36 QOPI Certification Program Participation by Practice Size (FTE) SIZE BY FTE MEDICAL ONCOLOGIST 4% 1% 7% 30% 23% 35%

37 QOPI Certification Program Practice by Ownership 35% Applicant Prac)ce Type, Rounds % 3% 17% Academic Full- Time Private with Academic Affilia)on Private Independent 26% 5% Employee Employee - Hospital Based Other

38 Review concordance with the 20 program standards Patient Tracer Policy Review Record Review Staff Interviews On-Site Survey Focus is one of coaching/ mentoring by the surveyors Surveyors are advanced degree oncology nurses with special training to conduct audits Report of Findings: practice-specific improvement roadmap Requirements Best practice suggestions Targeted education Tools (e.g., policy templates) Copyright 2016 American Society of Clinical Oncology. All rights reserved. 37

39 Quality Training Program Purpose Oncology providers design, implement and lead successful quality improvement (QI) activities in their practice settings. Oncologists assume quality leadership positions and champion quality initiatives. Design/ Curriculu m 6-month, comprehensive education and training for interdisciplinary oncology teams. Structured improvement project selected by each team In-person and virtual learning sessions with expert Faculty and Improvement Coaches experienced in oncology; Topics: improvement science, team building, and leadership. Knowledge and skills to lead local QI activities. Value/ Benefits 38 Expert assistance to complete a QI project. Achieve and sustain improvements processes of care; clinical outcomes.

40 Participant and Practice Benefits Completed projects using proven QI tools and techniques. Measurable improvements in cancer care. Fellows and junior faculty launch and expand QI careers. I was not familiar with any structured approach to quality improvement. The ASCO Quality Training Program provided a framework and guidance through our first effective team project. pilot participant Quality improvement felt nebulous. What I did not know is how scientifically-based quality improvement work is, and this program gave me the roadmap and tools. pilot participant 39

41 Key Information for ASCO Quality Training Program, 2016 WHERE: ASCO headquarters in Alexandria, VA: WHEN: (Three in-person sessions) July 13-14, 2016 October 5-6, 2016 January 26, 2017 COST:(Members & Friends of ASCO price): $1,750 per person.

42 How to Apply or Obtain More Information: Go to ASCO website: Contact: Barbara Corning-Davis Ph:

43 Clinical Affairs Special Projects UVA Darden School of Business MBA student project ASCO Practice Account Manager Pilot 2017 Oncology Business Conference 2016 MACRA practice workshops MIPS and OCM measurement packages