{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T22:25:21Z","timestamp":1787178321513,"version":"build-2736575974"},"reference-count":92,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"8","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncol Pract"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>We offer the perspectives of two veterans on the last quarter century of quality improvement efforts in oncology care. We believe that our colleagues deliver high quality care, but challenges remain in demonstrating this assertion to patients, payers, policy makers and to our colleagues. The journey began with the American College of Surgeons (ACOS) establishing minimum standards for cancer surgery in 1919 and evolved through state cancer registries, culminating in the Surveillance, Epidemiology, and End Results (SEER) program. Donabedian's structure-process-outcome framework and Porter's value equation provided conceptual frameworks for action. ASCO developed the Quality Oncology Practice Initiative (QOPI) in 2002. Physician-led self-assessment and chart abstraction could drive improvement. QOPI expanded to include certification programs and safety standards. Integrating quality measurement and improvement with payment incentives has proven challenging. Medicare's successive payment reform attempts\u2014from Resource-Based Relative Value (RBRVS) through the Oncology Care Model (OCM) to the Enhancing Oncology Model\u2014have shown mixed results, with minimal to no improvements in quality measures and limited cost-savings. Private payer initiatives based on clinical pathways largely failed to reduce costs and have been scaled back. Contemporary challenges include vertical integration of health care systems without clear quality benefits, rising drug costs, physician burnout, and erosion of public trust. New tools and iterations offer hope: artificial intelligence (AI)\u2013powered clinical documentation and analysis could dramatically reduce administrative burdens, cross-platform electronic record sharing should enable longitudinal quality analysis, and restoration of patient agency through market forces and social media may better align quality incentives. We posit that better future results require returning to bottom-up, physician-led quality improvement while leveraging AI and data-sharing technologies to make quality measurement a natural component of cancer care rather than an externally imposed burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/op-25-01060","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T19:59:05Z","timestamp":1780948745000},"page":"1434-1443","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Don't Cancer Doctors Offer Good-Quality Care?"],"prefix":"10.1200","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7931-4533","authenticated-orcid":true,"given":"Douglas W.","family":"Blayney","sequence":"first","affiliation":[{"name":"Stanford Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3708-0636","authenticated-orcid":true,"given":"Micheal N.","family":"Neuss","sequence":"additional","affiliation":[{"name":"Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_5_2_2","volume-title":"The Yale Book of Quotations","author":"Thompson (Lord Kelvin) W","year":"2006","unstructured":"Thompson (Lord Kelvin) W: The Yale Book of Quotations. Yale University Press; 2006"},{"key":"e_1_3_5_3_2","volume-title":"The \u201cMinimum Standard\u201d Document","author":"American College of Surgeons","unstructured":"American College of Surgeons: The \u201cMinimum Standard\u201d Document. https:\/\/www.facs.org\/about-acs\/archives\/past-highlights\/minimumhighlight\/"},{"key":"e_1_3_5_4_2","first-page":"475","article-title":"The first fifty years of the Connecticut Tumor Registry: Reminiscences and prospects","volume":"59","author":"Haenszel W","year":"1986","unstructured":"Haenszel W, Curnen MG: The first fifty years of the Connecticut Tumor Registry: Reminiscences and prospects. Yale J Biol Med 59:475-484, 1986","journal-title":"Yale J Biol Med"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30905"},{"key":"e_1_3_5_6_2","volume-title":"About the SEER Program","author":"SEER","unstructured":"SEER: About the SEER Program. https:\/\/seer.cancer.gov\/about\/overview.html"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1605101"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.2307\/3348969"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1011024"},{"key":"e_1_3_5_10_2","volume-title":"Berkshire Hathaway. Shareholder Letters","author":"Buffet W","year":"2021","unstructured":"Buffet W: Berkshire Hathaway. Shareholder Letters, 2021"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.20.1.137"},{"key":"e_1_3_5_12_2","volume-title":"Joint Commission","author":"Home","unstructured":"Home: Joint Commission. https:\/\/www.jointcommission.org\/en-us"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2020-063064"},{"key":"e_1_3_5_14_2","volume-title":"About the Commission on Cancer","author":"American College of Surgeons","unstructured":"American College of Surgeons: About the Commission on Cancer. https:\/\/www.facs.org\/quality-programs\/cancer-programs\/commission-on-cancer\/about\/"},{"key":"e_1_3_5_15_2","volume-title":"NCDB Data Submission","author":"American College of Surgeons","unstructured":"American College of Surgeons: NCDB Data Submission. https:\/\/www.facs.org\/quality-programs\/cancer-programs\/national-cancer-database\/ncdb-data-submission\/"},{"key":"e_1_3_5_16_2","volume-title":"Ensuring Quality Cancer Care","author":"Hewitt M","year":"1999","unstructured":"Hewitt M, Simone JV. Institute of Medicine (US) and National Research Council (US) National Cancer Policy Board (US). Ensuring Quality Cancer Care. Washington, DC: National Academies Press, 1999"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.03.3365"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.05.948"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2013.000992"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.14.2992"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMbkrev58584"},{"key":"e_1_3_5_22_2","volume-title":"Boston Globe","author":"Knox R","year":"2021","unstructured":"Knox R: Doctor\u2019s orders killed cancer patient: Dana-Farber admits drug overdose caused death of Globe columnist, damage to second woman. Boston Globe. 2021"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03530010049034"},{"key":"e_1_3_5_24_2","volume-title":"Palm Harbor Oncologist Convicted of Buying Unapproved Cancer Medications from Foreign Sources and Defrauding Medicare","author":"Middle District of Florida","year":"2016","unstructured":"Middle District of Florida. Palm Harbor Oncologist Convicted of Buying Unapproved Cancer Medications from Foreign Sources and Defrauding Medicare. Tampa, FL: United States Department of Justice, 2016. https:\/\/www.justice.gov\/usao-mdfl\/pr\/palm-harbor-oncologist-convicted-buying-unapproved-cancer-medications-foreign-source"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2008.030874"},{"key":"e_1_3_5_26_2","volume-title":"Orange County Medical Center and Doctor Who Bilked Medicare Agree to Pay $7.5 Million to Settle Fraud Case","year":"2011","unstructured":"Orange County Medical Center and Doctor Who Bilked Medicare Agree to Pay $7.5 Million to Settle Fraud Case. Santa Ana, CA: U.S. Department of Justice, 2011. https:\/\/www.fbi.gov\/losangeles\/press-releases\/2011\/orange-county-medical-center-and-doctor-who-bilked-medicare-agree-to-pay-7.5-million-to-settle-fraud-case"},{"key":"e_1_3_5_27_2","first-page":"459","article-title":"Wrong patient receives chemotherapy","volume":"37","author":"Cohen M","year":"2002","unstructured":"Cohen M: Wrong patient receives chemotherapy. Hosp Pharm 37:459-460, 2002","journal-title":"Hosp Pharm"},{"key":"e_1_3_5_28_2","volume-title":"Radiation Offers New Cures, and Ways to Do Harm","author":"Bogdanich W","unstructured":"Bogdanich W: Radiation Offers New Cures, and Ways to Do Harm. N Y Times, https:\/\/www.nytimes.com\/2010\/01\/24\/health\/24radiation.html"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0164"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2023.41.16_suppl.e15005"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2017.148"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.77.6385"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40261-023-01268-5"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.1264"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.24.00216"},{"key":"e_1_3_5_36_2","first-page":"279","article-title":"ONS Guidelines\u2122 to support patient adherence to oral anticancer medications","volume":"49","author":"Belcher SM","year":"2022","unstructured":"Belcher SM, Mackler E, Muluneh B, et al: ONS Guidelines\u2122 to support patient adherence to oral anticancer medications. Oncol Nurs Forum 49:279-295, 2022","journal-title":"Oncol Nurs Forum"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.56.8899"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.21.6770"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2011.000313"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2013.000886"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.091045"},{"key":"e_1_3_5_42_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.18.00654"},{"key":"e_1_3_5_43_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.21.00167"},{"key":"e_1_3_5_44_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.091043"},{"key":"e_1_3_5_45_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.38.5740"},{"key":"e_1_3_5_46_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.10392"},{"key":"e_1_3_5_47_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2010.0526"},{"key":"e_1_3_5_48_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.18.00410"},{"key":"e_1_3_5_49_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1263"},{"key":"e_1_3_5_50_2","volume-title":"New Data on Cancer Disparities in Washington","author":"Mapes D","year":"2019","unstructured":"Mapes D. New Data on Cancer Disparities in Washington. Seattle, WA: Fred Hutchinson Cancer Research Institute, 2019. https:\/\/www.fredhutch.org\/en\/news\/center-news\/2019\/05\/new-data-on-cancer-health-disparities-in-washington.html"},{"key":"e_1_3_5_51_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.36.30_suppl.310"},{"key":"e_1_3_5_52_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12094-016-1545-6"},{"key":"e_1_3_5_53_2","unstructured":"White J Puthumana J Cram P et al: Reforming Medicare Quality Measurement. Health Affairs Forefront. 2025. https:\/\/www.healthaffairs.org\/content\/forefront\/reforming-medicare-quality-measurement"},{"key":"e_1_3_5_54_2","volume-title":"Medicare Physician Payment: An Agenda for Reform: [Annual Report to Congress]","author":"United States. Physician Payment Review Commission","year":"1987","unstructured":"United States. Physician Payment Review Commission: Medicare Physician Payment: An Agenda for Reform: [Annual Report to Congress]. Washington, D.C.: Physician payment review commission; 1987"},{"key":"e_1_3_5_55_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198809293191330"},{"key":"e_1_3_5_56_2","volume-title":"H.R.3299\u2014101st Congress (1989-1990)]: Omnibus Budget Reconciliation Act of 1989","author":"Rep. Panetta L. [D C 16.]","year":"1989","unstructured":"Rep. Panetta L. [D C 16.]: H.R.3299\u2014101st Congress (1989-1990)]: Omnibus Budget Reconciliation Act of 1989, 1989. https:\/\/www.congress.gov\/bill\/101st-congress\/house-bill\/3299"},{"key":"e_1_3_5_57_2","volume-title":"Public Law 105\u201333 105th Congress","year":"1997","unstructured":"Public Law 105\u201333 105th Congress. 1997"},{"key":"e_1_3_5_58_2","unstructured":"Public Law 114-10: 2015. https:\/\/www.govinfo.gov\/content\/pkg\/PLAW-114publ10\/html\/PLAW-114publ10.htm"},{"key":"e_1_3_5_59_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.17642"},{"key":"e_1_3_5_60_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2023.41.16_suppl.1512"},{"key":"e_1_3_5_61_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.2023.19.11_suppl.2"},{"key":"e_1_3_5_62_2","volume-title":"Oncology Care Model | CMS","author":"Centers for Medicare & Medicaid Services","unstructured":"Centers for Medicare & Medicaid Services: Oncology Care Model | CMS. https:\/\/www.cms.gov\/priorities\/innovation\/innovation-models\/oncology-care"},{"key":"e_1_3_5_63_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.7156"},{"key":"e_1_3_5_64_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.9852"},{"key":"e_1_3_5_65_2","unstructured":"Centers for Medicare & Medicaid Services: EOM (Enhancing Oncology Model). CMS. https:\/\/www.cms.gov\/priorities\/innovation\/innovation-models\/eom"},{"key":"e_1_3_5_66_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2015.005256"},{"key":"e_1_3_5_67_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.18.00479"},{"key":"e_1_3_5_68_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.5631"},{"key":"e_1_3_5_69_2","first-page":"OP2500498","article-title":"Oncology medical homes: ASCO-community oncology alliance standards","author":"Woofter K","year":"2025","unstructured":"Woofter K, Kennedy EB, Adelson K, et al: Oncology medical homes: ASCO-community oncology alliance standards. JCO Oncol Pract OP2500498, 2025","journal-title":"JCO Oncol Pract"},{"key":"e_1_3_5_70_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2013.001019"},{"key":"e_1_3_5_71_2","volume-title":"Evaluation of CMS\u2019s Oncology Care Mode","author":"Abt Global","unstructured":"Abt Global: Evaluation of CMS\u2019s Oncology Care Mode. https:\/\/www.abtglobal.com\/insights\/publications\/report\/evaluation-of-cmss-oncology-care-model"},{"key":"e_1_3_5_72_2","volume-title":"Oncology Care Model: What Did We Learn?","author":"Fischer L","unstructured":"Fischer L: Oncology Care Model: What Did We Learn? Oncology Nursing News, https:\/\/www.oncnursingnews.com\/view\/oncology-care-model-what-did-we-learn-"},{"key":"e_1_3_5_73_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.4133"},{"key":"e_1_3_5_74_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.0024"},{"key":"e_1_3_5_75_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.22.00329"},{"key":"e_1_3_5_76_2","volume-title":"EOM (Enhancing Oncology Model)","author":"CMS","unstructured":"CMS: EOM (Enhancing Oncology Model). https:\/\/www.cms.gov\/priorities\/innovation\/innovation-models\/eom"},{"key":"e_1_3_5_77_2","first-page":"1","article-title":"Clinical pathways and the oncology medical home: First steps to value-based patient care","volume":"9","author":"Doyle C","year":"2016","unstructured":"Doyle C: Clinical pathways and the oncology medical home: First steps to value-based patient care. Am Health Drug Benefits 9:1-9, 2016","journal-title":"Am Health Drug Benefits"},{"key":"e_1_3_5_78_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2016.020503"},{"key":"e_1_3_5_79_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2010.000193"},{"issue":"1","key":"e_1_3_5_80_2","first-page":"S1","article-title":"Equity in cancer care: Pathways, protocols, and guidelines","volume":"10","author":"DeMartino JK","year":"2012","unstructured":"DeMartino JK, Larsen JK: Equity in cancer care: Pathways, protocols, and guidelines. J Natl Compr Cancer Netw 10:S1-S9, 2012. (suppl 1)","journal-title":"J Natl Compr Cancer Netw"},{"key":"e_1_3_5_81_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2015.009134"},{"key":"e_1_3_5_82_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.23.00632"},{"key":"e_1_3_5_83_2","unstructured":"Office USGA: Health care consolidation: Published estimates of the extent and effects of physician consolidation | U.S. GAO 2025. https:\/\/www.gao.gov\/products\/gao-25-107450"},{"key":"e_1_3_5_84_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.53275"},{"key":"e_1_3_5_85_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2020.7536"},{"key":"e_1_3_5_86_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2025.03.016"},{"key":"e_1_3_5_87_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMms2510427"},{"key":"e_1_3_5_88_2","unstructured":"Public LAW 114-255. 2016. https:\/\/www.govinfo.gov\/content\/pkg\/PLAW-114publ255\/pdf\/PLAW-114publ255.pdf"},{"key":"e_1_3_5_89_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.6413"},{"key":"e_1_3_5_90_2","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.25.0040"},{"key":"e_1_3_5_91_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.1904"},{"key":"e_1_3_5_92_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2416064"},{"key":"e_1_3_5_93_2","unstructured":"Chen S Gutierrez K Salehi S et al: AI clinical coach 2025. https:\/\/med.stanford.edu\/edtech\/portfolio\/ai-clinical-coach.html"}],"container-title":["JCO Oncology Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/OP-25-01060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T21:59:24Z","timestamp":1787176764000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/OP-25-01060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":92,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1200\/OP-25-01060"],"URL":"https:\/\/doi.org\/10.1200\/op-25-01060","relation":{},"ISSN":["2688-1527","2688-1535"],"issn-type":[{"value":"2688-1527","type":"print"},{"value":"2688-1535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2025-10-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-09","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}