Personal Perspectives Regarding the QOPI Certification Process

Introduction

The journey toward international recognition may be challenging, especially when one is benchmarked against many competitors in accordance with certain measures. In the late 1990s, ASCO recognized the need to define the quality of care by its members.¹ Joseph Simone, MD (pediatric oncologist), developed the Quality of Oncology Practice Initiative (QOPI) Program, which was piloted in 2002 and opened to all ASCO members in 2006, and the certification program was launched in 2010.¹ QOPI is among the most prestigious certifications awarded to hematology/oncology outpatient centers in North America and worldwide. This certification indicates that a center has implemented updated best practices and evidence-based medicine in the field of oncology. The QOPI evaluates the medical management of a patient and related documentation, whereas the QOPI Certification Pathway (QCP) evaluates the standard operating procedures of a practice, safety of chemotherapy administration, continuing education, and other aspects. During this process, surveyors must visit the practice, observe events on the floor by shadowing a few patients, and review related documents. As an administrator for a QOPI participating institution, I have reflected on my experiences in this article.

QOPI Modules

A module is a set of measures established to address an evidence-based practice area related to a specific disease and is thus named after the disease (eg, breast module, colorectal cancer module). QOPI has nine modules. The measures of the core module are shared among other eight modules and must be selected alongside at least one additional module (Fig 1).¹ “A ‘Core’ is a set of measures applied to all charts that addresses topics such as the documentation of diagnoses, pain assessment, narcotic and analgesic assessment, chemotherapy planning, chemotherapy administration, a chemotherapy treatment summary, psychological support, and smoking cessation counseling.”^1(p8) In addition, three classic reporting methods are applied in this context: the QOPI Certification Pathway (QCP), Patient-Centered Oncology Practice, and Physician Quality Reporting System–Oncology Measures Group. The latter is applicable only to practices in the United States (Fig 2).¹

Fig 1.

Classic Quality of Oncology Practice Initiative (QOPI) modules (2016). (*) Required modules for QOPI Certification Pathway (QCP) track. Reprinted with permission.¹

Fig 2.

Quality of Oncology Practice Initiative (QOPI) reporting pathway (2016). CMS, Centers for Medicare and Medicaid Services; Eps, eligible professionals; NCQA, National Committee for Quality Assurance PCOP, Patient-Centered Oncology Practice; PQRS-OMG, Physician Quality Reporting System–Oncology Measures Group; QCP, QOPI Certification Pathway; Reprinted with permission.¹

The QCP can be divided into two approaches to subscription: QCP measures only, which comprises 25¹ items, or the QCP and other selected disease modules. The 25 measures included in the QCP track include measures procured from the breast cancer, colorectal cancer, non–small-cell lung cancer, care at end of life, symptoms/toxicity management, and core measures. In addition to the QCP track, a new practice would be highly advised to select all applicable modules. This choice would fulfill two important aspects: testing the practice against rigorous measures and ensuring practitioners’ engagement in all specialties, because non-Hodgkin lymphoma, gynecology-oncology, palliative, and pancreatic modules are not included among the 25 measures in the QCP track.

The Roadmap

The QOPI Certification Roadmap comprises five phases conducted over a period of 24 months, or the equivalent of three to four QOPI rounds, and depends on the performance of the practice. Here, I describe my perspective throughout these phases and suggest practices that might be considered to ensure a clear path toward certification (Fig 3).

Fig 3.

Quality of Oncology Practice Initiative (QOPI) certification roadmap. All time intervals are subject to change by ASCO-QOPI. (*) Required modules for QOPI Certification Pathway (QCP) track.

Phase I (Preround Preparation)

During this phase, practices are advised to begin preparing for the QOPI certification 9 to 12 weeks before the start of the first round. During this phase, a practice should do the following:

• Assign the QOPI to a corresponding physician and administrator:

  • The corresponding physician communicates concerns purely related to medical practice to the QOPI team and vice versa. It is highly recommended that this physician be knowledgeable about the practice process as well as the QOPI measures.

  • The Program Administrator leads the team and plans the processes and logistics needed to achieve QOPI certification.

• Use a 2-year timeline roadmap (Fig 3).

• Foster education about the QOPI by delivering presentations and communicating measures and materials.

• Foster staff engagement and team formation:

  • Form a QOPI team that will review and abstract charts using the QOPI portal.

  • The QOPI team should comprise oncology practitioners, specifically physicians and nurses familiar with the process, documentation, and locations of the required information.

  • It is highly recommended to select computer-oriented individuals to compose the team.

  • Have fewer clinical assignments for the team, especially during the chart abstraction period.

  • Inspire the team and make them believe that they are making a change for the better with their practice and that sustaining this improvement is their responsibility

Phase II (First Round)

Specifically, this would involve choosing to participate in the QCP Track and all applicable modules. The required target charts depend on the total full-time equivalent of the hematology/oncology practitioners (Table 1).¹ Although it is important to reach the target chart numbers, the chart reviewer team can impute missing numbers from other modules if they cannot find enough eligible charts to submit for certain modules.

Table 1.

Chart Requirements on the Basis of FTEs

Phase III

Phase III reports are released when the round ends. This gap analysis should focus on the measures for which the practice received scores of 80% or less. During this phase, forms should be redesigned and developed to address the missing required measures indicated in the final report document. A practice should aim to complete the required changes before the start of the next round. These changes will simplify the chart review process during a later round (ie, maintenance of QCP certification 1 year later).

Phase IV (Second Round)

This phase is considered the second round for a practice. At this time, a practice is highly recommended to select only the QCP without any other modules. Selecting this pathway would guarantee three important aspects: a team focused on limited modules, the inclusion of only 25 measures for review during the chart abstraction process, and a smaller number of eligible charts relative to the previous round. These aspects will reduce stress and ensure sufficient time for the team to review the abstracted charts before submission. Ten days before the closure of this round, the QOPI will post an interim certification report that is considered a preliminary report of practice performance against the QCP measures. This is an ample time to carry out any required review and corrective action for the abstracted charts.

Phase V

This phase begins 2 to 3 weeks after the closure of the previous round. At this time, if a practice has already met the QCP score (75% or greater), it must undergo the certification process within a 12-month period, which begins immediately after signing the legal documents and submitting payment. If a practice does not pass, the gap analysis should be repeated and the underperforming measures should be addressed (Fig 3: QOPI Certification Roadmap).

My Suggested Tips

• For international use: the QOPI portal uses the following date format (m/dd/yy). Therefore, ensure that data are communicated among the team using the short-form date (eg, Jan, Feb) wherein the month is spelled out.

• Each chart reviewer must document the generated QOPI chart identification number with the matching medical record number.

• When inputting data into the QOPI portal, ask the team to use the suppressed feature and do not submit data unless the fed charts have been reviewed.

• When identifying documentation gaps within your practice, physicians with skills in using MS Word software and who are knowledgeable about QOPI measures should be appointed from each specialty to develop/amend the existing forms as well as process. This will speed up the changeover process.

• Assign at least two members of the chart reviewer team to review the suppressed charts and ensure that data are fed correctly, especially during the second round.

• To ensure compliance and sustainability of the redesigned process, especially documentation, after achieving the required score (75%), the practice should develop an auditing tool that comprises only the required QCP measures and ensures the compliance of practitioners by conducting random checks on the charts on a periodic basis (Table 2).

Table 2.

Suggested Auditing Tool

AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The following represents disclosure information provided by author of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc.

Ziad Alzahrani

No relationship to disclose