Practice Matters

News from Lola Butcher about health policy and practice management issues of importance to oncologists

Monday, January 7, 2013

‘Fiscal Cliff’ Legislation Includes Possible Hat Tip to QOPI


The term “Quality Oncology Practice Initiative” does not appear in the so-called fiscal cliff legislation that Congress approved on New Year’s Day, but the new law provides an opening for QOPI to become an essential component of every oncologist’s practice.


The law signed by President Obama on Jan. 2 sets the stage for physicians to submit data on quality measures via a “qualified clinical data registry” in lieu of participating in the Physician Quality Reporting System (PQRS), beginning in 2014.


Many details about what exactly constitutes a “qualified clinical data registry” remain to be worked out. The law assigns the Department of Health and Human Services to establish requirements for the registries.


If QOPI meets the requirements to be a qualified registry, it would mean that oncologists could satisfy the federal government’s quality reporting requirements through QOPI, the ASCO-developed system that 15 percent of oncologists are currently using to benchmark their performance against other practices.


Oncologists have been unhappy with PQRS since it was introduced as a pilot program (then called Physician Quality Reporting Initiative) six years ago, saying that the government’s measures were mostly irrelevant to cancer care and that submitting data was more trouble than it was worth. Most oncologists have not submitted quality data to PQRS, choosing to forego financial bonuses offered by the government.


Opting out of PQRS, however, is about to become a more difficult financial decision. Beginning this year, physicians who do not successfully submit data to PQRS will receive a 1.5% decrease in their Medicare pay in 2015.


ASCO leaders have been discussing the idea of allowing QOPI to be an alternative to PQRS with officials at the Centers for Medicare & Medicaid Services and Congress for several months, said Charles Penley, MD, chair of ASCO’s governmental relations committee.


In testimony before the U.S. Senate Committee on Finance Roundtable last July, Barbara McAneny, MD, chief executive office of the New Mexico Oncology Hematology Consultants, urged Congress to allow QOPI to be the data-reporting vehicle for oncologists who participate in the government’s e-Prescribing Program and other reporting programs.


“While ASCO strongly supports the goals of these initiatives, we have shared with CMS that these programs are often duplicative and subject to unrealistic timelines,” she said. “The use of QOPI could serve as a central program to replace or streamline most of the existing CMS reporting requirements, save significant resources and provide much more granular and meaningful information beyond what can be achieved with CMS-directed programs.”


The “fiscal cliff” legislation identifies the following elements that might be required for a qualified clinical data registry:

·    Provides for transparency of data elements and specifications, risk models, and measures

·    Requires the submission of data from participants with respect to multiple payers

·    Provides timely performance reports to participants at the individual participant level

·    Supports quality improvement initiatives.


The law instructs the Government Accountability Office to conduct a study on the potential of clinical data registries to improve the quality and efficiency of care in the Medicare program¸ including through payment incentives. Its report is due by Nov. 15.