providers, this individual should be allowed to receive reimbursement provided that (as specified in the recommendation above) he or she meets the plan’s quality and other standards. The provider should also accept reimbursement at rates paid to similar providers within the plan’s network.
In recognition that full implementation of the above recommendation will not by itself ensure the provision of appropriate psychosocial health services, the committee also makes the following recommendation.
Recommendation: Quality oversight. The National Cancer Institute, CMS, and AHRQ should fund research focused on the development of performance measures for psychosocial cancer care. Organizations setting standards for cancer care (e.g., National Comprehensive Cancer Network, American Society of Clinical Oncology, American College of Surgeons’ Commission on Cancer, Oncology Nursing Society, American Psychosocial Oncology Society) and other standards-setting organizations (e.g., National Quality Forum, National Committee for Quality Assurance, URAC, Joint Commission) should
Create oversight mechanisms that can be used to measure and report on the quality of ambulatory oncology care (including psychosocial health care).
Incorporate requirements for identifying and responding to psychosocial health care needs into their protocols, policies, and standards.
Develop and use performance measures for psychosocial health care in their quality oversight activities.
The research to be funded will need to transform concepts to be measured into technical specifications, pilot test the measures, audit a sample of measures to ensure their accuracy, analyze and display measurement results, and address how the accuracy and reliability of the measures will be maintained over time. The committee expects that these activities will make use of already established mechanisms and organizations that currently perform these functions, but that some funding may be needed to support certain other activities, such as the initial development of the measure specifications.
The committee also believes that a small number of measures (five or fewer) should be targeted for development, and that these could consist of structural as well as process and outcome-of-care measures. Structural measures are typically addressed in accreditation processes and could be used to deal with such areas of concern as whether a health plan or clinical practice requires or uses a validated instrument or approach to identify systematically all cancer patients with psychosocial needs. Patient report