Laura Levit

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Therefore, in 2012, the IOM convened a committee of experts to examine the quality of cancer care in the United States and formulate recommendations for improvement. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents the committee’s findings and recommendations.

Beyond the HIPAA Privacy Rule Enhancing Privacy Improving Health Through Research

This report contains the findings of a committee charged with reviewing the HIPAA privacy rule and its impact on health research. The committee found that the rule does not adequately protect the privacy of people’s personal health information and hinders important health research. It recommends that Congress authorize the development of an entirely new approach to protecting personal health information in research that applies privacy, data security, and accountability standards uniformly to information used in all health-related research regardless of who funds or conducts it.

Ensuring Quality Cancer Care Through the Oncology Workforce

A summary of the discussion at the Institute of Medicine National Cancer Policy Forum Workshop to examine oncology workforce shortages and describe current and potential solutions.

The Institute of Medicine Report on High-Quality Cancer Care: Implications for Oncology Nursing

PURPOSE/OBJECTIVESnTo present key recommendations from a recently released Institute of Medicine (IOM) report on high-quality cancer care.nnnDATA SOURCESnThe recommendations were derived from the IOM report Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis.nnnDATA SYNTHESISnThe authors reviewed each of the recommendations to identify implications for oncology nurses.nnnCONCLUSIONSnNurses will play a vital role in the future design and delivery of high-quality cancer care.nnnIMPLICATIONS FOR NURSINGnOncology nurses should use the IOM recommendations in their settings to prepare for the delivery of oncology care amidst health system challenges, including an aging society.nnnKNOWLEDGE TRANSLATIONnThe IOM recommendations identify key areas of concern to nurses. Key aspects of nursing practice, including involvement in advanced care planning, patient-centered care, and evidence-based practice, are essential for high-quality care. Oncology nurses will be centrally involved in healthcare innovations, such as rapid learning systems, and as key members of a well-trained workforce.

Charting a New Course for the Delivery of High-Quality Cancer Care

Cancer is one of the most complicated diseases to diagnose and treat, requiring sophisticated pathological and imaging studies that are evaluated by multiple independent health care professionals. Most cancer therapies are expensive and toxic, and patients are treated with them for prolonged periods of time. When a person is told they have cancer, they often “shut down” and no longer hear anything further about the treatments that are being recommended. They enter a complex and fragmented cancer care system in which palliative care and psychosocial support are inadequately provided and hospice referral occurs far too late in the course of treatment. Many of these issues were identified in the transformative 1999 Institute of Medicine (IOM) report “Ensuring Quality Cancer Care,” which recommended structural changes to cancer care delivery and the development of a quality monitoring system. Unfortunately, many of the gaps in cancer care that the IOM identified more than a decade ago have been magnified today as a result of an explosion in knowledge of cancer biology, earlier diagnosis as a result of screening, more indications for adjuvant and multimodal therapies, and increasing numbers of long-term survivors. Cancer care accounts for a substantial proportion of health care expenditures, and the delivery system is being stressed by the aging of the population. The quality of cancer care in the United States is uneven, with few metrics to assess treatment outcomes among practitioners and in various clinical settings. With increasing demand for services, anticipated workforce shortages, and the rising costs of cancer care, delivery of affordable, accessible, high-quality cancer care in the future is in jeopardy. Given this situation, in 2012, an IOM committee composed of 17 individuals from diverse clinical backgrounds (medicine, nursing, oncology specialties, geriatrics, ethics, health outcomes research, palliative care, and patient advocacy) was asked to examine these issues and to make recommendations on how to improve the quality

Improving the quality of cancer care in America through health information technology

A recent report from the Institute of Medicine titled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, identifies improvement in information technology (IT) as essential to improving the quality of cancer care in America. The report calls for implementation of a learning healthcare IT system: a system that supports patient-clinician interactions by providing patients and clinicians with the information and tools necessary to make well informed medical decisions and to support quality measurement and improvement. While some elements needed for a learning healthcare system are already in place for cancer, they are incompletely implemented, have functional deficiencies, and are not integrated in a way that creates a true learning healthcare system. To achieve the goal of a learning cancer care delivery system, clinicians, professional organizations, government, and the IT industry will have to partner, develop, and incentivize participation.

Improving the Quality of Cancer Care: Implications for Palliative Care

BACKGROUND AND OBJECTIVEnIn September 2013 the Institute of Medicine (IOM) released a report on the quality of cancer care in the United States. We report here on the recommendations of the IOM report and the implications for the palliative care community.nnnMETHODSnThe IOM report is based on a consensus of literature and expert opinion. The recommendations provide direction for health policy, education, and clinical practice. The report emphasizes the significance of the aging population and implications for cancer care.nnnRESULTSnThe recommendations from the report offer many opportunities for palliative care including enhancing the use of advance care planning and integration of palliative care across the cancer trajectory.nnnCONCLUSIONSnQuality cancer care depends on the integration of quality palliative care. The palliative care community can use this IOM report to guide their collaboration with oncology and to enhance the quality of care provided to cancer patients and their families.

The State of Oncology Practice in America, 2018: Results of the ASCO Practice Census Survey

PURPOSEnTo describe the US hematology and medical oncology practice landscape and to report findings of the sixth annual ASCO Oncology Practice Census survey.nnnPARTICIPANTS AND METHODSnASCO used Medicare Physician Compare data to characterize oncology practices in the United States. Practice size, number of care sites, and geographic distribution were determined. Trends in the number and size of practices from 2013 to 2017 were examined. All US oncology practices were targeted for the survey; survey responses were linked to the practices identified from Physician Compare to augment results and assess generalizability.nnnRESULTSnMore than 2,200 hematology/oncology practices provided care to adult patients in 2017. We observed annual decreases in the number of practices and annual increases in practice size. Of the 2017 practices, 394 (18%) completed the survey and accounted for 58% of the US hematologist/oncologist workforce (n = 7,203). Respondents tended to be larger and encompass more sites of care than nonrespondents. Surveyed practices cited payers (58%), competition (38%), and staffing (37%) as primary sources of strain. Prior authorization was dominant among payer pressures (78%). Electronic health records remained a burden on practices, with only 15% reporting full interoperability.nnnCONCLUSIONnThe results of ASCOs 2017 survey indicate that oncology practices are challenged by day-to-day operations, often related to payment, reimbursement, and competition. Our findings likely represent conservative estimates of such burdens because they are driven by responses from midsized to large-sized organizations, which have lower relative administrative burden, greater market influence, and potentially better ability to adapt in a changing health care environment.

Impact on Oncology Practices of Including Drug Costs in Bundled Payments

INTRODUCTIONnThis analysis evaluates the impact of bundling drug costs into a hypothetic bundled payment.nnnMETHODSnAn economic model was created for patient vignettes from: advanced-stage III colon cancer and metastatic non-small-cell lung cancer. First quarter 2016 Medicare reimbursement rates were used to calculate the average fee-for-service (FFS) reimbursement for these vignettes. The probabilistic risk faced by practices was captured by the type of patients seen in practices and randomly assigned in a Monte Carlo simulation on the basis of the given distribution of patient types within each cancer. Simulations were replicated 1,000 times. The impact of bundled payments that include drug costs for various practice sizes and cancer types was quantified as the probability of incurring a loss at four magnitudes: any loss, > 10%, > 20%, or > 30%. A loss was defined as receiving revenue from the bundle that was less than what the practice would have received under FFS; the probability of loss was calculated on the basis of the number of times a practice reported a loss among the 1,000 simulations.nnnRESULTSnPractices that treat a substantial proportion of patients with complex disease compared with the average patient in the bundle would have revenue well below that expected from FFS. Practices that treat a disproportionate share of patients with less complex disease, as compared with the average patient in the bundle, would have revenue well above the revenue under FFS. Overall, bundled payments put practices at greater risk than FFS because their patient case mix could greatly skew financial performance.nnnCONCLUSIONnIncluding drug costs in a bundle is subject to the uncontrollable probabilistic risk of patient case mixes.

Trial Reporting in Immuno-Oncology (TRIO): An American Society of Clinical Oncology-Society for Immunotherapy of Cancer Statement.

PURPOSEnTo develop recommendations for clinical trial reporting that address the unique efficacy, toxicity, and combination and sequencing aspects of immuno-oncology (IO) treatments.nnnMETHODSnASCO and the Society for Immunotherapy of Cancer (SITC) convened a working group that consisted of practicing medical oncologists, immunologists, clinical researchers, biostatisticians, and representatives from industry and government to develop Trial Reporting in Immuno-Oncology (TRIO) recommendations. These recommendations are based on expert consensus, given that existing data to support evidence-based recommendations are limited.nnnCONCLUSIONnThe TRIO recommendations are intended to improve the reporting of IO clinical trials and thus provide more complete evidence on the relative benefits and risks of an IO therapeutic approach. Given the rapid expansion of the number of IO clinical trials and ongoing improvements to the evidence base supporting the use of IO treatments in clinical care, these recommendations will likely need regular revision as the IO field develops.