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The demand for widely vetted, physician-level quality measures continues to grow. Recent legislation (The Tax Relief and Health Care Act of 2006) and programs from the Centers for Medicare & Medicaid Services (CMS) require measures developed through a multidisciplinary consensus process that includes an open public comment period. The American Medical Association (AMA)–convened Physician Consortium for Performance Improvement (PCPI) is the primary physician-led organization devoted to generating quality measures using a process that meets these criteria.
Broad-based physician-level measures are needed in oncology, and the American Society of Clinical Oncology (ASCO) has been active for many years in quality measure development (Table 1.). To address this need, ASCO partnered with the American Society for Therapeutic Radiology and Oncology (ASTRO) and the AMA PCPI in March 2007 to develop oncology clinical performance measures.
Under the leadership of Patricia A. Ganz, MD, (ASCO co-chair), and James Hayman, MD, (ASTRO co-chair), an interdisciplinary group of more than 45 members convened to review candidate measures proposed by ASTRO and ASCO. Several of the measures are derived from the ASCO/ National Comprehensive Cancer Network (NCCN) Quality Measures; developed in coordination with the NCCN for quality assessment at the group or institutions level; and from ASCO's Quality Oncology Practice Initiative. The Oncology Measures are listed in Table 2.
Many of the measures resulting from the AMA PCPI/ASTRO/ASCO workgroup are intended to replace the current oncology measures in the CMS Physician Quality Reporting Initiative (PQRI). For that reason, and to facilitate implementation in other settings, the measures are specified for data collection through the billing claims system. Codes were specified for these measures, including International Classification of Diseases, ninth revision and Current Procedural Terminology (Evaluation & Management Codes, Category I codes) to identify the appropriate population, and Category II codes to report the numerator for the measure.
The PCPI was established to take a leadership role in the development, testing, and maintenance of evidence-based clinical performance measures and measurement resources for physicians. ASCO and ASTRO are members of the PCPI, along with more than 100 national medical specialty and state medical societies; the Council of Medical Specialty Societies; American Board of Medical Specialties and its member boards; experts in methodology and data collection; the Agency for Healthcare Research and Quality; and CMS.
PCPI develops performance measures through cross-specialty work groups focused on specific clinical conditions. Performance measures developed by PCPI and lead organizations are intended to be:
The Consortium seeks to specify measures for implementation using multiple data sources, including paper medical records, administrative data, and particular emphasis on electronic health record systems.
The AMA PCPI posted the oncology measures for public comment in August 2007. The full PCPI membership will vote on the proposed measure set in fall 2007, and the final set will be published online. The final oncology measure set will also be reviewed by the AQA in fall 2007. Measures supported by the AQA will be eligible for inclusion in the 2008 CMS PQRI program. Finally, the measures will be submitted to the National Quality Forum to seek endorsement as national consensus standards.