I think that there is no ambiguity about the importance of outcomes in patient care and the fact that this is the direction in which health-care reimbursement is moving.
—Robert S. Miller, MD, FACP, FASCO
On December 3, 2014, Robert S. Miller, MD, FACP, FASCO, will start his new position as Medical Director of ASCO’s Institute for Quality (iQ). Established in 2012 to oversee the development of clinical practice guidelines, the Quality Oncology Practice Initiative (QOPI), the QOPI Certification Program, Performance Measures and Practice Improvement, and CancerLinQ, iQ provides ASCO members with the resources necessary to ensure that every patient receives the highest level of oncology care.
Currently Assistant Professor of Oncology and Oncology Medical Information Officer at the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins University School of Medicine in Baltimore, Dr. Miller is a pioneer in health-related information technology and an expert on social media for professional education and patient engagement. He has served on ASCO’s Board of Directors, the Quality of Care Committee, the Clinical Practice Committee, the Cancer Education Committee, the Integrated Media and Technology Committee, and the Health Information Technology Workgroup. He is also currently Editor-in-Chief of Cancer.Net and is on the editorial board of the Journal of Oncology Practice.
An ASCO member since 1992, Dr. Miller said he decided to join ASCO as Medical Director of the Institute for Quality because, “ASCO’s vision for the future of oncology has always been something that has resonated with me personally.”
The ASCO Post talked with Dr. Miller about his immediate goals for iQ, the biggest obstacles to quality improvement in cancer care, and his decision to make a career change.
Please talk about your new position as Medical Director of ASCO’s Institute for Quality. What are some of your priorities?
My job will be to provide medical oversight and bring a clinician’s perspective to the Institute for Quality’s initiatives. One area of particular focus will be ASCO’s learning health system CancerLinQ, which is scheduled to launch next year.
Among the things I’ll bring to my position as Medical Director of iQ is an ability to provide more regular input as a physician into the Institute’s quality improvement efforts. I have practiced both in an academic medical center setting and in the community practice setting, so I’ve seen both sides in terms of some of the pressures oncologists face (and I think there are more similarities than differences in the two modes of practice).
Right now, ASCO’s quality initiatives are under the purview of the Quality of Care Committee and a number of important CancerLinQ committees. The fact that ASCO is a volunteer, mission-driven organization is not going to change, but I think the Society decided to create this new position because having someone on staff with my background who can provide consistent input in these areas will help strengthen ASCO’s effort to improve the quality of cancer care.
To some extent, I’m going to be discovering exactly how my insights will be useful in the first year I’m here, but I think the idea for hiring me was that ASCO needed specific medical oversight on the development and implementation of some of these programs.
Measuring and Improving Quality
What role does quality measurement play in physician reimbursement, and how is quality improvement being incorporated into the American Board of Internal Medicine’s (ABIM’s) Maintenance of Certification program?
We are working to transition reimbursement from a quantity-based system tied only to face-to-face patient encounters to one that reimburses physicians for medical outcomes. This is a very complex area, and clearly we do not have one structure in place yet, but quality measurement will continue to rise in importance because oncologists will need feedback for practices to remain viable. Oncologists have to know how they are doing in meeting the various quality metrics and how they compare with their peers.
No one quite yet has the vision about how the nuts and bolts are going to work, but I think that there is no ambiguity about the importance of outcomes in patient care and the fact that this is the direction in which health-care reimbursement is moving.
A secondary aspect of quality improvement is adherence to the ABIM’s Maintenance of Certification (MOC) program. ABIM recently changed its MOC program, which now requires physicians to have continuous engagement in MOC activities, and these changes will become integral to daily practice.
What do you see as the biggest obstacle to quality improvement?
The biggest obstacle to quality improvement is probably access to quality measurement data. Despite the fact that the majority of oncology practices now use electronic health records, we still struggle with extracting meaningful, specialty-specific quality measurement data from our systems to know how we are doing even in our own practices.
One of the advantages of the QOPI program is that it forces oncology practices to look at very specific quality measurement indicators. Although we’ve seen a marked increase in the adoption of electronic health records, as a specialty we are still struggling to identify what metrics we are meeting in our practices and what the outcomes and improvements might be. I think that will be key to the future of quality improvement efforts.
What made you decide to make this change in your oncology career?
ASCO’s vision for the future of oncology has always been something that has resonated with me personally. ASCO’s guiding principle is that all patients with cancer should have access to high-quality care and that information learned from every patient should accelerate the progress against cancer. These are the things that I really believe in as an oncologist.
In my current position, I’m a clinician and I’m involved in informatics, and in those roles I can have some influence over a single institution. But this position potentially allows me to benefit cancer patients everywhere. It is a great opportunity to become involved in a visionary organization like ASCO, where the staff is passionate about this mission. I’m hoping it allows me the opportunity to focus my energies and interests on more global areas and enable me to have a broader impact than I could at my single institution.
One thing I have clearly learned is that when you work in an institution, you have a responsibility to your patients, of course, and to the goals of the institution when it comes to administrative responsibilities. I realized that I would not be able to focus on these important, more global ASCO initiatives if I continued to be employed where I am now. It is a bit of a leap and a change for me professionally, but I am really excited about starting my new position. ■
Disclosure: Dr. Miller reported no potential conflicts of interest.