Act Locally: Quality and Safety in Head and Neck Care

The importance of tracking data is to look for outliers and best practices, said Dr. Weber. At M.D. Anderson, we constantly review our data and make changes where and when necessary. We can then compare our data with our colleagues’ to see if we are meeting or exceeding certain benchmarks.

Shape of Things to Come

As Dr. Shine indicated in his presentation, pay-for-performance [P4P] is here to stay and physicians need to be proactive about identifying the things they wish to be paid for and get on board.

Although there are many constituents already in place that are driving P4P, Dr. Weber highlighted two programs in particular. The Premier Hospital Quality Incentive Program is overseen by Premier, Inc., a nationwide consortium of 270 nonprofit hospitals and health systems offering financial bonuses to reward its members for performance in select clinical areas. The rewards are based on quality measures extensively validated by AHRQ, the Joint Commission on Accreditation of Health care Organizations (JCAHO), and the National Quality Forum (NQF); funding is provided by the Centers for Medicare and Medicaid Services (CMS) (www.premierinc.com .

Similarly, the Leapfrog Hospital Rewards Program™ measures hospital performance on five conditions for effectiveness and affordability; hospitals that demonstrate excellence or that show improvement along both dimensions will be rewarded. The Leapfrog Group strongly supports evidence-based hospital referrals (EHR) based on volume and mortality criteria-that is, directing patients with high-risk conditions to hospitals with characteristics shown to be associated with better outcomes. The Leapfrog Group is a voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry that big leaps in health care safety, quality, and customer value will be recognized and rewarded (www.leapfroggroup.com ).

Dr. Weber recommended the creation of a three-tier model of head and neck cancer care so that patients can be directed to institutions with subspecialty expertise and the support infrastructure to provide optimum care. This model would be driven by purchasers, CMS, managed care organizations, and informed patients, who would incentivize providers and institutions to move these patients through the system from a community hospital to a regional and/or tertiary cancer center where they can be placed with a trained head and neck oncology specialist who is part of a multidisciplinary care team. These head and neck cancer specialists must have completed not only basic surgical training, but also general otolaryngology, head and neck surgery, and advanced head and neck surgical oncology training.