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Evolving Issues in Oncology
January 2, 2020

Adding Patient-Reported Outcomes to Medicare’s Oncology Value-Based Payment Model

Author Affiliations
  • 1Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
  • 2Associate Editor, JAMA
  • 3Value-Based Care and Quality Programs, Texas Oncology, Dallas
  • 4Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
JAMA. 2020;323(3):213-214. doi:10.1001/jama.2019.19970

On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) Innovation Center released details of a proposed alternative payment model for medical oncology care, called Oncology Care First (OCF), for public comment.1 The OCF model will succeed the Oncology Care Model (OCM), which will expire at the end of 2020. When it started in 2016, the OCM, which was voluntary, was important in oncology due to its emphasis on value-based care transformation.

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    1 Comment for this article
    No Need To Reinvent the Wheel on PROs
    Thomas Hilton, PhD | Retired NIH
    I was disappointed that the authors did not mention the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) which is a computerized adaptive PRO tool specifically designed and validated to monitor patient recovery from most diseases and injuries.

    Originally conceived in 2001 by several NIH program officials (myself included), PROMIS represents the first trans-NIH project, an R&D investment of roughly $250 million. The project has involved hundreds of medical researchers and psychometricians. The goal of PROMIS was to use standardized language and validated measures consistent with the suggestions in this paper. PROMIS is available
    in numerous languages and is in use around the globe. More information can be found at http://www.promishealth.org/.

    Although paper-and-pencil versions of all domains are available, the computerized version is what makes PROMIS the ideal tool. Developed on the basis of all published items at the time, PROMIS employed Modern Measurement Theory and computerized adaptive testing (CAT) technology to produce symptoms and life adjustment measures that minimize patient burden (time and effort), and can be completed on a home PC. Moreover, hundreds of published studies attest to its precision and validity.

    Finally, what makes PROMIS special as a research tool is its "tau equivalence." Because items were selected from a pool of all published measures, there is a very high correlation between legacy measures and PROMIS measures. Thus, PROMIS enables building on existing PRO databases.