Thomas W. Feeley

Senior Fellow

Thomas W. Feeley, M.D. is a Senior Fellow at the Harvard Business School and the Helen Shafer Fly Distinguished Professor of Anesthesiology at the University of Texas MD Anderson Cancer Center in Houston, Texas.   He is the Head of both the Division of Anesthesiology and Critical Care and the Institute for Cancer Care Innovation at the University of Texas MD Anderson Cancer Center. Dr. Feeley received both undergraduate and M.D. degrees from Boston University and trained in anesthesiology and critical care at Boston’s Beth Israel Hospital.  He was a faculty member at Stanford University for 19 years practicing cardiovascular anesthesia and critical care. 

Thomas W. Feeley, M.D. is a Senior Fellow at the Harvard Business School and the Helen Shafer Fly Distinguished Professor of Anesthesiology at the University of Texas MD Anderson Cancer Center in Houston, Texas.   He is the Head of both the Division of Anesthesiology and Critical Care and the Institute for Cancer Care Innovation at the University of Texas MD Anderson Cancer Center. Dr. Feeley received both undergraduate and M.D. degrees from Boston University and trained in anesthesiology and critical care at Boston’s Beth Israel Hospital.  He was a faculty member at Stanford University for 19 years practicing cardiovascular anesthesia and critical care.  In 1997 he came to MD Anderson to create and lead the Division of Anesthesiology and Critical Care. His Division of Anesthesiology and Critical Care is the largest program of its kind devoted to cancer anesthesiology and critical care. He served for 7 years as the Vice President of Medical Operations.   His work with the Institute for Cancer Care Innovation focuses on research to demonstrate and improve the value of cancer care delivery. He regularly teaches value-based health care at the Harvard Business School with Professor’s Porter and Kaplan.  Dr. Feeley recently served on the Institute of Medicine’s Committee on Improving the Quality of Cancer Care: Addressing the Needs of an Aging Population that produced the report titled Delivering High-Quality Cancer Care:  Charting a New Course for a System in Crisis that was released in September of 2013. Dr. Feeley was recently appointed by Texas Governor Rick Perry to the Board of Directors of the Institute for Health Care Quality and Efficiency.  At Harvard Business School he will be working with Professors Michael Porter and Robert Kaplan on research and education in the value-based health care agenda with an emphasis on the role of information technology in health care. In addition to his research, teaching and administrative roles, Dr. Feeley provides patient care services in the delivery of anesthesia.

Journal Articles

  1. A Cancer Center Puts the New Approach to Work: Pilot

    The University of Texas MD Anderson Cancer Center is a National Cancer Institute–designated Comprehensive Cancer Center, located in Houston, Texas. Seeing more than 30,000 new patients every year, MD Anderson accounts for approximately 20% of cancer care within the Houston region and 1% of cancer care nationally. MD Anderson is a medical condition–focused center that provides integrated, interdisciplinary care across the care cycle.
    In collaboration with Michael Porter, we embarked on a major effort to expand clinical outcome measurement, beginning with a study of 2,468 patients in the Head and Neck Center, in 2008. We created the Institute for Cancer Care Excellence in December 2008 to support this effort. In 2010, with Robert Kaplan, we launched a pilot project, also within the Head and Neck Center, to assess the feasibility of applying modern cost accounting to health care delivery.

    Keywords: health care; health care quality; measurement; Costing; Accounting; Health; Quality; Health Industry; North and Central America;

    Citation:

    Albright, Heidi W., and Thomas W. Feeley. "A Cancer Center Puts the New Approach to Work: Pilot." R1109B. Harvard Business Review 89, no. 9 (September 2011): 15–16. (This article is a sidebar description of a pilot of time-driven activity-based costing in the HBR article "How to Solve the Cost Crisis in Health Care" by Robert S. Kaplan and Michael E. Porter.) View Details
  2. The Implications of the 2010 Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act on Cancer Care Delivery

    In March 2010, President Obama signed into law the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. This legislation attempts to address cost control and improve the quality of healthcare in the United States. Cancer is a major health problem in the United States and the leading cause of death for Americans under the age of 80. Therefore, cancer care providers need to be fully engaged in ongoing discussions regarding quality measurement and care delivery.With the optimum level of collaboration and support, the proposals in the legislation can be properly structured to deliver improved access to care via better delivery systems, as well as more appropriate reimbursement to advance the prevention and treatment of cancer.

    Keywords: health care policy; health care; Cancer care in the U.S.; Cancer care services; Health; Law; Quality; Health Industry; North and Central America;

    Citation:

    Albright, Heidi W., Mark Moreno, Thomas W. Feeley, Ronald Walters, Marc Samuels, Alissa Pereira, and Thomas W. Burke. "The Implications of the 2010 Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act on Cancer Care Delivery." Cancer 117, no. 8 (April 15, 2011): 1564–1574. View Details
  3. A Method for Defining Value in Healthcare Using Cancer Care as a Model

    Value-based healthcare delivery is being discussed in a variety of healthcare forums. This concept is of great importance in the reform of the US healthcare delivery system. Defining and applying the principles of value-based competition in healthcare delivery models will permit future evaluation of various delivery applications. However, there are relatively few examples of how to apply these principles to an existing care delivery system. In this article, we describe an approach for assessing the value created when treating cancer patients in a multidisciplinary care setting within a comprehensive cancer center. We describe the analysis of a multidisciplinary care center that treats head and neck cancers, and we attempt to examine how this center integrates with Porter and Teisberg's (2006) concept of value-based competition based on the results analysis. Using the relationship between outcomes and costs as the definition of value, we developed a methodology to analyze proposed outcomes for a population of patients treated using a multidisciplinary approach, and we matched those outcomes to the costs of the care provided. We present this work as a model for defining value for a subset of patients undergoing active treatment. The method can be applied not only to head and neck treatments, but to other modalities as well. Public reporting of this type of data for a variety of conditions can lead to improved competition in the healthcare marketplace and, as a result, improve outcomes and decrease health expenditures.

    Keywords: value creation; Cancer care in the U.S.; healthcare; Health; Management; Measurement and Metrics; Health Industry; North and Central America;

    Citation:

    Feeley, Thomas W., Heidi Albright, Ronald Walters, and Thomas W. Burke. "A Method for Defining Value in Healthcare Using Cancer Care as a Model." Journal of Healthcare Management 55, no. 6 (November–December 2010): 399–412. (This article won the Edgar C. Hayhow Award from the American College of Healthcare Executive in 2012 as the article of the year in the Journal of Healthcare Management.) View Details
  4. Improving Cancer Care Through Public Reporting Of Meaningful Quality Measures

    Historically, quality measures for cancer have followed a different route than overall quality measures in the health care system. Many specialized cancer treatment centers were exempt from standard reporting on quality measures because of the complexity of cancer. Additionally, it has been difficult to create meaningful quality measures for cancer because the disease can strike so many different organs; is discovered at and progresses through different stages; and is treated using different modalities, such as surgery, radiation, and chemotherapy. Over the past decade the National Quality Forum, a nonprofit organization dedicated to bettering the quality of US health care, has endorsed measures of quality for cancer providers and patients. The Affordable Care Act of 2010, which has sections specific to cancer reporting, will also further the development and public reporting of cancer quality measures—important steps in improving the delivery of cancer care.

    Keywords: cancer; quality metrics; public reporting; Affordable care act; Quality; Health; Health Industry; North and Central America;

    Citation:

    Spinks, Tracy E., Ronald Walters, Thomas W. Feeley, Heidi Wied Albright, Victoria S. Jordan, John Bingham, and Thomas W. Burke. "Improving Cancer Care Through Public Reporting Of Meaningful Quality Measures." Health Affairs 30, no. 4 (April 2011): 664–672. (doi: 10.1377/hlthaff.2011.0089.) View Details
  5. Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicine’s 10 Recommendations for Improving the Quality of Cancer Care in America

    Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US health care system in the late 1990s. The National Cancer Policy Board (NCPB), a 20-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system in which patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. The report outlined 10 recommendations, which, when implemented, would: 1) improve the quality of cancer care, 2) increase the current understanding of quality cancer care, and 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating health care costs, has prompted national efforts to reform the health care system. These efforts by health care providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States.

    Keywords: cancer; quality; Cancer care in the U.S.; quality improvement; Health Care and Treatment; Health Industry; North and Central America;

    Citation:

    Spinks, Tracy E., Heidi W. Albright, Thomas W. Feeley, Ron Walters, Thomas W. Burke, Thomas Aloia, Eduardo Bruera, et al. "Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicine’s 10 Recommendations for Improving the Quality of Cancer Care in America." Cancer 118, no. 10 (May 15, 2012): 2571–2582. View Details
  6. Developing a System to Track Meaningful Outcome Measures in Head and Neck Cancer Treatment

    The health care industry, including consumers, providers, and payers of health care, recognize the importance of developing meaningful, patient-centered measures. This article describes our experience using an existing electronic medical record largely based on free text formats without structured documentation, in conjunction with tumor registry abstraction techniques, to obtain and analyze data for use in clinical improvement and public reporting.
    Methods
    We performed a retrospective analysis of 2467 previously untreated patients treated with curative intent who presented with laryngeal, pharyngeal, or oral cavity cancer in order to develop a system to monitor and report meaningful outcome metrics of head and neck cancer treatment. Patients treated between 1995 and 2006 were analyzed for the primary outcomes of survival at 1 and 2 years, the ability to speak at 1 year posttreatment, and the ability to swallow at 1 year posttreatment.
    Results
    We encountered significant limitations in clinical documentation because of the lack of standardization of meaningful measures, as well limitations with data abstraction using a retrospective approach to reporting measures. Almost 5000 person-hours were required for data abstraction, quality review, and reporting, at a cost of approximately $134,000. Our multidisciplinary teams document extensive patient information; however, data is not stored in easily accessible formats for measurement, comparison, and reporting.
    Conclusion
    We recommend identifying measures meaningful to patients, providers, and payers to be documented throughout the patients' entire treatment cycle, and significant investment in the improvements to electronic medical records and tumor registry reporting in order to provide meaningful quality measures for the future.

    Keywords: cancer treatment; Cancer care in the U.S.; outcomes measurement; Health; Health Industry; North and Central America;

    Citation:

    Walters, Ronald S., Heidi W. Albright, Randal S. Weber, Thomas W. Feeley, Ehab Y. Hanna, Scott B. Cantor, Carol M. Lewis, and Thomas W. Burke. "Developing a System to Track Meaningful Outcome Measures in Head and Neck Cancer Treatment." Head & Neck 36, no. 2 (February 2014): 226–230. View Details
  7. Improving the Quality of Cancer Care in America Through Health Information Technology

    A recent report from the Institute of Medicine titled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, identifies improvement in information technology (IT) as essential to improving the quality of cancer care in America. The report calls for implementation of a learning healthcare IT system: a system that supports patient–clinician interactions by providing patients and clinicians with the information and tools necessary to make well informed medical decisions and to support quality measurement and improvement. While some elements needed for a learning healthcare system are already in place for cancer, they are incompletely implemented, have functional deficiencies, and are not integrated in a way that creates a true learning healthcare system. To achieve the goal of a learning cancer care delivery system, clinicians, professional organizations, government, and the IT industry will have to partner, develop, and incentivize participation.

    Keywords: information technology; information technology industry; Cancer care in the U.S.; Health; Technology; Health Industry; North and Central America;

    Citation:

    Feeley, Thomas W., George W. Sledge, Laura Levit, and Patricia A. Ganz. "Improving the Quality of Cancer Care in America Through Health Information Technology." Journal of the American Medical Informatics Association (forthcoming). (Published online, December 2013.) View Details
  8. Measuring the Value of Process Improvement Initiatives in a Preoperative Assessment Center using Time-driven Activity-based Costing

    Background: The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing(TDABC)in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources.
    Problem: Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center(PAC).
    Goals: Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment.
    Strategy: Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency.
    Results: Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements.
    Implication:
    • TDABC can be applied in a health care setting.
    • TDABC allows for quantification of value in process improvements.
    • TDABC allows one to evaluate the value of identified process improvements.

    Keywords: quality improvement; value agenda; Time-Driven Activity-Based Costing; Accounting; Health; Measurement and Metrics; Value; Health Industry; North and Central America;

    Citation:

    French, Katy E., Heidi W. Albright, John C. Frenzel, James R. Incalcaterra, Augustin C. Rubio, Jessica F. Jones, and Thomas W. Feeley. "Measuring the Value of Process Improvement Initiatives in a Preoperative Assessment Center using Time-driven Activity-based Costing." Healthcare 1, nos. 3-4 (December 2013): 136–142. View Details
  9. Delivering High-quality Cancer Care: The Critical Role of Quality Measurement

    In 1999, the Institute of Medicine (IOM) published Ensuring Quality Cancer Care, an influential report that described an ideal cancer care system and issued ten recommendations to address pervasive gaps in the understanding and delivery of quality cancer care. Despite generating much fervor, the report's recommendations—including two recommendations related to quality measurement—remain largely unfulfilled.

    Amidst continuing concerns regarding increasing costs and questionable quality of care, the IOM charged a new committee with revisiting the 1999 report and with reassessing national cancer care, with a focus on the aging US population. The committee identified high-quality patient–clinician relationships and interactions as central drivers of quality and attributed existing quality gaps, in part, to the nation's inability to measure and improve cancer care delivery in a systematic way. In 2013, the committee published its findings in Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which included two recommendations that emphasize coordinated, patient-centered quality measurement and information technology enhancements:
    • Develop a national quality reporting program for cancer care as part of a learning health care system; and
    • Develop an ethically sound learning health care information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings.

    These recommendations underscore the need for independent national oversight, public–private collaboration, and substantial funding to create robust, patient-centered quality measurement and learning enterprises to improve the quality, accessibility, and affordability of cancer care in America.

    Keywords: health care quality; Health; Health Industry; North America;

    Citation:

    Spinks, Tracy, Patricia Ganz, George Sledge, Laura Levit, James Hayman, Timothy Eberlein, and Thomas W. Feeley. "Delivering High-quality Cancer Care: The Critical Role of Quality Measurement." Healthcare 2, no. 1 (March 2014): 53–62. View Details
  10. Second Opinion Pathology Review is a Patient Safety Mechanism that Helps Reduce Error and Decrease Waste

    We have a crisis in health care delivery, originating from increasing health care costs and inconsistent quality-of-care measures. During the past several years, value-based health care delivery has gained increasing attention as an approach to control costs and improve quality. One proven way to control costs and improve the quality of health care is subspecialty pathologic review of patients with cancer before initiation of therapy. Our study examined the diagnostic error rate among patients with cancer treated at a tertiary care hospital and demonstrated the value of subspecialty pathologic review before initiation of treatment.
    Methods: From September 1 to September 30, 2011, all patients seeking a clinical consultation had pathology submitted to and reviewed by a pathologist with subspecialty expertise and correlated in our pathology database.
    Results: A total of 2,718 patient cases were reviewed during September 2011. There was agreement between the original pathologist and our departmental subspecialty pathologist in 75% of cases. In 25% of cases, there was a discrepancy between the original pathology report and the subspecialty final pathology report; 509 changes in diagnosis were minor discrepancies (18.7%), and in 6.2% of patients (169 reports), the change in diagnosis represented a major discrepancy that potentially affected patient care.
    Conclusion: Second review of a patient's outside pathology by a subspecialist pathologist demonstrates the value of multidisciplinary cancer care in a high-volume comprehensive cancer center. The second review improves clinical outcomes by providing patients with evidence-based treatment plans for their precise pathologic diagnoses.

    Keywords: Pathology; diagnostic errors; Health; Health Industry; North and Central America;

    Citation:

    Middleton, Lavinia, Ronald Walters, Thomas W. Feeley, and Stanley Hamilton. "Second Opinion Pathology Review is a Patient Safety Mechanism that Helps Reduce Error and Decrease Waste." Journal of Oncology Practice 10, no. 4 (July 2014): 275–280. (e-Pub 4/2014.) View Details