Enhancing end-of-life quality metrics: The role of palliative care in a community oncology practice.

85 Background: As value-based payment (VBP) models expand in oncology, care teams adopt innovative strategies to improve outcomes, enhance patient experience, and meet evolving quality metrics (QMs). These changes require reassessing traditional population health QMs to ensure they reflect current practices and continue to incentivize care improvements. End-of-life care is one area where timely access to hospice remains inconsistent—especially in rural and underserved communities—and often outside oncology practices' direct control. Additionally, advances like immunotherapy, which may be well tolerated near end-of-life, challenge the hospice model as the sole supportive care option. NCCN and ASCO guidelines recommend early palliative care in advanced cancers, and many community oncology practices now integrate palliative care-to provide longitudinal, goal-concordant care that supports quality of life throughout treatment. Including palliative care receipt in end-of-life QMs offers a more nuanced, equitable way to evaluate care, ensuring patients receive needed support regardless of geography or treatment stage. Methods: We conducted a retrospective analysis of Enhancing Oncology Model (EOM) episodes in Performance Periods 1 and 2 (PP1 and PP2) for patients attributed to Tennessee Oncology, a large community-based practice with embedded palliative care-trained APPs and physicians. The analysis focused on EOM Quality Measure 2 (QM2): the proportion of patients who died and were enrolled in hospice for at least three days before death. To assess the impact of embedded palliative care, we recalculated QM2 with a modified numerator including patients who either enrolled in hospice at least three days before death or had a documented palliative care evaluation and management (E&M) visit at least three days before death, divided by all patients who died during the episode. Results: Among 2,135 unique patients attributed to PP1 and PP2, 335 died within their episode timelines. Of these, 47.7% (n = 160) were admitted to hospice, and 34.9% (n = 117) were referred to hospice at least three days before death. When including patients with palliative care E&M visits at least three days before death, the recalculated QM2 increased to 52.8% (n = 177), reflecting a 17.9 percentage point improvement in performance by incorporating palliative care interventions. Conclusions: Access to palliative care is critical to improving outcomes, patient satisfaction, and reducing costs. However, common VBP metrics do not fully capture innovations in palliative care delivery within community oncology. Future VBP models should recognize and incentivize these innovations through updated quality measures that are consistent with guidelines.