Chicago–A new certification program run by the American Society of Clinical Oncology (ASCO) is offering oncology practices an objective and plug-in methodology to receive independent verification that they are meeting current standards. At press time, the first 16 community-based oncology programs across the United States had just been certified through this Quality Oncology Practice Initiative (QOPI). The certification is entirely voluntary and, according to ASCO, “demonstrates a commitment to excellence.” As of yet, it is unclear how widely or quickly certification will catch on among other practices, but those who have gone through the certification are pleased.

Practical Benefits

QOPI certification has the potential to improve care by verifying measures of performance, but it also might be characterized as an ASCO seal of approval. Therefore, it may provide a competitive advantage for community-based cancer treatment facilities that are attempting to negotiate with insurers. If patients accept QOPI certification as an important distinction when selecting a cancer center, it also may become a valuable means of demonstrating quality and attracting patients. When asked about their reason for participating, however, oncologists from several of the newly certified centers emphasized that the real value of QOPI is to provide a reliable and reproducible method of quality assurance.

“There was work involved in adopting our system to capture the information required for participation, but we think that the effort to document what we do does makes us sharper and improves our care,” said Usha Sree Chamarthy, MD, a hematologist/medical oncologist at Sparrow Regional Cancer Center, Lansing, Mich. “We have always been very engaged in quality improvement in our center because we are very committed to confirming that we were keeping up with evolving standards. When this came around, we decided to use this approach as our platform after discussing whether we thought it was going to have value for us.”

Dr. Chamarthy’s practice and others participating in QOPI certification report that the program has helped tighten procedures and increased efforts to document quality. For example, Dr. Charmathy reported that although several routine procedures, such as smoking cessation and fertility counseling, already were being offered by physicians at her center, they were not necessarily documented. QOPI certification, which requires such documentation, has created a platform on which to demonstrate a high standard of care.

According to those involved in helping launch the initiative, the most important function of QOPI is to reveal weaknesses so that they can be repaired. For example, outgoing president of ASCO, Douglas Blayney, MD, a leader of the initiative to launch QOPI, said the initiative’s performance measurement could identify problems. “At our center, we found that we were significantly more likely than our peers to offer chemotherapy to patients within two weeks of their death,” said Dr. Blayney, referring to his work at the University of Michigan. This led to a series of procedural changes within the oncology team, reducing the proportion of patients receiving chemotherapy shortly before death from 50% to 20%. Dr. Blayney indicated that this is a pertinent example of the types of activities that can be overlooked if they are not evaluated and assessed with rigorous and reproducible methodology. Dr. Blayney recently was appointed medical director of the Stanford Cancer Center, Stanford University, Stanford, Calif.

How It Works

QOPI certification is based on an assessment of performance by two methods. The first involves a survey of patient records, in which a series of specific quality-of-care measures are evaluated. The second is a site assessment. In the evaluation of patient records, the measures mostly are evidence-based, although some are derived from expert consensus opinion. There are a growing number of measures, including 17 specific chemotherapy safety standards, that are being employed in the QOPI certification program. Certification must be renewed every three years.

The program was created primarily for community-based cancer care facilities, which provide more than 80% of all cancer treatment in the United States, according to ASCO estimates. QOPI certification requires a fee to cover the expenses of the assessment, but the program may pay for itself by eliminating other quality control efforts and outcomes improvements, as well as adding value for health plan reimbursement. According to ASCO, no information about practice performance will be released without the consent of the practice. Additionally, practices can use the data internally for recognizing areas of weakness and opportunities to improve.

Some oncologists are concerned that a voluntary quality assurance program eventually may be transformed into a mandatory quality assurance initiative, but not everyone is concerned that this will be a bad outcome. Although third-party payers who insist on quality assurance may produce this result with or without QOPI certification, improved outcomes are a reasonable expectation. Dr. Blayney defended the QOPI certification initiative on this basis. He not only emphasized that it is a quality assurance program designed by oncologists for oncologists, but it really does have the potential to improve care.

“All of us want to do the right thing for our patients, and this program is a tool for getting that result,” Dr. Blayney reported.