Response from the Commission on Cancer of the American College of Surgeons to the IOM Report, “Delivering High-Quality Cancer Care: Charting a New Course for System in Crisis”
The American College of Surgeons Commission on Cancer (CoC) supports the Institute of Medicine’s (IOM) thought generating committee report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis released September 10, 2013. The report highlights specific recommendations for the improvement of the quality of cancer care delivery. The CoC was a sponsoring organization of the report and will play a key role in the exploration of and implementation of the report’s recommendations going forward.
Is our cancer care delivery system in crisis? Today cancer care delivery already is becoming more coordinated, more patient-centered, and more evidence-based due in no small part to the efforts of health care providers, payors, researchers, patient advocacy organizations, professional organizations and standard-setting groups like The American College of Surgeons Commission on Cancer. Collaboration among these groups and consideration of the cost of implementation will drive the future of cancer care delivery but systems already are in place and moving in a positive direction toward integration of patient-centered care, evidence-based care, and high-quality cancer care delivered to cancer patients close to home.
Following is a statement from CoC Chair, Daniel McKellar, MD, FACS:
“The Commission on Cancer has been the leader in quality reporting in cancer care since it was established in 1922. The CoC establishes cancer program standards and serves as the voluntary accrediting body for cancer programs across the country. Since 2005, the CoC has provided its accredited cancer programs with an annual Cancer Program Practice Profile Report (CP3R) which assists cancer programs in monitoring compliance with quality measures and benchmarking. The CoC also provides immediate feedback on quality measure compliance through our Rapid Quality Reporting System that tracks outcomes in “real time” for clinicians and cancer programs and provides reminders when a quality measure is not met for individual patients. The IOM report highlights the CoC’s National Cancer Data Base (NCDB) that tracks cancer care delivery in all accredited cancer programs in which over 70 percent of all newly diagnosed cancer patients in the United States are treated.
The CoC is recognized in the IOM report and we are proud to have been a champion in improving quality and ensuring patient-centered care for cancer patients. The CoC is working with many professional organizations to develop and implement new quality measures in multiple cancer sites and in cancer care delivery.
Cancer is a multifaceted disease and its complexity makes it challenging to treat. The CoC has been a leader in the development and monitoring of quality measures for cancer care and holding cancer programs accountable for compliance with standards and measures of quality. The CoC will continue to work with accredited programs and others to ensure the delivery of high quality, patient-centered care as outlined in the goals of the recommendations found in this IOM report. “
The CoC views progress and potential in the following areas of cancer care:
- Patient-Centered Communication and Shared Decision Making
In its manual, Cancer Program Standards 2012: Ensuring Patient-Centered Care the CoC shifted focus from standards for accreditation that primarily defined the structure and processes of the cancer program to include new standards to enhance patient-centered functions and define performance criteria in quality measurement and outcomes.
A Survivorship Care Plan Standard was developed to track compliance with delivery of a care plan to an individual patient upon their completing cancer treatment. The CoC analyzed recommendations from several previous IOM reports and developed and implemented new Continuum of Care Standards that go into effect in 2015 include survivor care plans, Patient Navigation Process and a standard for Psychosocial Distress Screening.
The CoC has implemented standard requiring programs to have Palliative Care Services available for cancer patients. CoC Standards include requirements for programs to inform patients about clinical trials and supportive services. As programs formulate their approach to compliance with these requirements, the CoC will work to share best practices to assist others on approaches to enhance care to individuals with cancer.
- Learning Health Care Information Technology System for Cancer
The development of a Learning Health Care Information Technology System is an innovative, forward-thinking approach to the integration of clinical practice and clinical research while maximizing the use of quality metrics reporting systems to enhance cancer care provision. In order for data-sharing to take place in such an environment, a model that promotes easy accessibility will need to be designed with cost and legal considerations.
- Translating Evidence into Practice, Measuring Quality, and Improving Performance
As noted in the IOM report, the CoC has incorporated the National Quality Forum (NQF) endorsed measures into the CoC quality reporting tools. Quality measures reported in the Cancer Program Practice Profile Report (CP3R) have been incorporated into the CoC Standards as either Quality Accountability Measures or Quality Improvement measures. CoC requires cancer programs be compliant with these measures at a threshold set by the CoC.
The Rapid Quality Reporting System (RQRS) was developed to overcome the issue of the delay between diagnosis, data submission, and reporting back to the accredited facilities, a problematic issue reported in the IOM report (7-14). This tool is concurrent and prospective in nature in that the tool provides alerts to the cancer programs of forthcoming adjuvant care required to provide evidence-based care. In addition, the RQRS provides comparative reports on compliance rates with quality measurement at the state and national levels. The tool provides a summary of the care a patient receives, and in so doing can become the beginning of a Survival Care Plan. The RQRS is currently voluntary and available as a benefit of CoC accreditation.
The CoC’s Quality Integration Committee approves quality measures to be utilized for reporting to CoC-accredited programs. Measures for esophagus, gastric, rectal, and non-small cell lung cancer were passed by the Quality Integration Committee’s May 2013 meeting. These measures will be reported starting in 2014. Currently, the CoC is collaborating with organizations to develop ovarian, endometrium, and cervical measures; melanoma, breast and prostate quality cancer measures. The CoC is actively encouraging accredited programs to publicly report outcomes by including a new standard that provides commendation for programs that publicly report outcomes from their cancer program. For example, the CoC is working with the Pennsylvania Health Care Quality Alliance (PHCQA) to allow accredited programs to post their quality measure data on a public website. The American College of Surgeons CoC has a contract with The Centers for Medicare and Medicaid Services (CMS) to plan and implement reporting of cancer care measures on behalf of the 11 Prospective Payment System (PPS) exempt cancer hospitals (PCH). The process for data collection, analysis, and reporting will occur is through utilization of the RQRS. The requirement for public reporting by the PCHs is defined in Section 3005 of the Patient Protection and Affordable Care Act (ACA). These measures will be posted on the Hospital Compare website. This IOM report does credit the CoC with having voluntary programs that have demonstrated improvements in cancer care but reports that the activities have been siloed. The CoC is working hard to collaborate with professional organizations and governmental agencies to enhance public reporting of quality outcomes and is encouraged by efforts that suggest participation in CoC accreditation is a symbol of excellence in cancer care.
- Accessible and Affordable Cancer Care
In addition to the CoC efforts outlined above the CoC has a newly formed full committee addressing advocacy and health policy impacting cancer patients. Through these efforts, the CoC has been at the table to address issues such as payment systems, quality tracking systems, cancer disparities and challenges of workforce shortages and workforce training needs. The CoC was asked to participate in the Choosing Wisely initiative and as suggested in the IOM report, was one of the organizations invited to identify and disseminate evidence-based information about cancer care practices deemed unnecessary or where harm outweighs benefits.
While the CoC commends the IOM for its recent report, the CoC does not view our current cancer care system as one “in crisis.” CoC standards— which are already in place at more than 1,500 of its accredited cancer programs—set a high bar: one that the CoC has found accredited programs are eager to meet. The CoC has been a leader in the development and monitoring of quality measures for cancer care and for holding cancer programs accountable for compliance with standards and measures of quality. The CoC will continue to work with accredited programs and other stakeholders to ensure the delivery of high quality, patient-centered care as outlined in the goals of the recommendations found in this IOM report.
About the Commission on Cancer
The Commission on Cancer is a consortium of 52 professional organizations that establish cancer care standards and monitor quality at hospitals that it accredits. More than 1,500 hospitals in the United States and Puerto Rico are CoC accredited, representing only 30 percent of all institutions but more than 70 percent of all new cancer cases diagnosed annually. The CoC is administered by the Chicago-based American College of Surgeons.