NCRA 39th Annual Educational Conference

NCRA was an incredible experience.  The national and local coordinators did an excellent job with topics, speakers and site management.  Presenters speaking to some very exciting topics on the linking of quality measures to Medicare reimbursement under the Affordable Healthcare Act (AHCA), the American Taxpayer Relief Act (ATRA), Health Information Technology and Economic and Clinical Health Act (HITECH) and the implementation of ICD 10M.  As new provisions of these laws roll out over 2013 and 2014 you will be interested to know I think how this impacts cancer registries.  Under these acts the model of fee for service is being replaced by fee for performance as Medicare reimbursement will be tied to meeting specified quality measures.  Meaningful use of the electronic health record to improve quality of care was discussed at length.  Reporting cancer cases to the state cancer registry is one of the menu options for compliance by eligible providers.  Participating in the Rapid Quality Reporting System through the Commission on Cancer (CoC) accreditation process has been recognized by the Centers for Medicare/Medicaid Services (CMS) as meeting one of the quality measures for hospitals.  RQRS is only available to CoC approved hospitals. The Hospital Inpatient Quality Reporting (HOQR) mandated by Medicare in 2003 and the Hospital Outpatient Quality Reporting (HOQR) mandated in 2006 reduces reimbursement to hospitals that do not report compliance with quality measures (57 measures).  The Centers for Medicare/Medicaid Services (CMS) is currently testing oncology quality measures with 11 hospitals nationwide.  As part of this project CMS has contracted with the CoC to provide performance measure data (CP3R) for these pilot hospitals.   The CoC has submitted five new quality measures to the National Quality Forum for endorsement.  The quality measures for Standards 4.4 and 4.5 will be expanded as well as existing measures enhanced.  The next measure up for consideration is the number of mediastinal lymph nodes taken in a staging mediastinoscopy for lung cancer cases.  A new version of the CoC program standards manual is due out in July 2013.

How will this come together and how will it affect your registry?  Truthfully, I don’t think the process is completely defined.  There are a variety of options for eligible providers and eligible hospitals to meet quality measures.  These measures must necessarily have some flexibility to their structure since not all hospitals provide the same clinical services or have the same patient mix or clinical needs.  For hospitals who have a significant cancer population though, it is not a stretch to say that administrators are biased to using existing data sources rather than inventing new ones.  The use of clinical registries to document outcomes that affect reimbursement may put new focus on the cancer registry.  In light of CMS already recognizing participation in RQRS as a qualifying performance measure, those hospitals already approved by the CoC may be better positioned to document compliance with quality of care and improve their reimbursement.  In addition, the CMS is aware of the quality measures already in place in approved hospitals and publication of that data is part of the pilot project underway.  The emphasis on measurable quality outcomes may spur a more extensive use of registry data and build relationships with other departments.  The cancer registry as an isolated data enclave may be going the way of the dinosaur.  How is your registry positioned for this transition?  Do you know your data?  Do you trust it?  Quality and completeness have always been important, they are essential now.  What can you do to be ready to promote the administrative and clinical applications of the registry data?  What are your thoughts on the benefits and challenges to a more “meaningful use” of registry data? 

Hospital Inpatient Quality Reporting Requirements:  https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1138900297065

Hospital Outpatient Quality Reporting Requirements:  https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1192804531207

NQF Endorsed Measures Related to Cancer Care:  https://www.qualityforum.org/Publications/2012/06/Performance_Measurement_Coordination_Strategy_for_PPS-Exempt_Cancer_Hospitals.aspx

Hospital Compare Website:  www.hospitalcompare.hhs.gov

http://www.healthit.gov/policy-researchers-implementers/meaningful-use

http://www.hhs.gov/healthcare/rights/law/index.html

http://cms.gov/Medicare/Coding/ICD10/index.html

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