OBJECTIVES: The 2015 Medicare Access and CHIP Re-authorization Act (MACRA) will base physician payments on quality-of-care. This system will rely on specific outcomes and patient metrics to assign a composite performance score; however, there are inherent challenges to measuring and improving upon that score. Here, we reviewed the current standing of oncology end-of-life care, and how VeriStrat® testing and other tools can help physicians improve quality care at end-of-life. METHODS: This study was conducted through a systematic literature review of clinical trials, survey-based studies, medical practice guidelines and reports on the following oncology topics: Establishing prognosis (including advanced diagnostic laboratory tests), referral to hospice or best-supportive care, and patient quality-of-life. RESULTS: The review of Merit-based Incentive Payment System (MIPS) and Oncology Care Model (OCM) Quality measures identified specific quality metrics related to end-of life care for oncology patients -overtreatment at end-of life, late or no hospice referral, and hospital admissions- and underscored the importance of establishing and communicating prognosis. When informed of poor prognosis, patients and physicians were less likely to select aggressive treatments, more likely to engage in early palliative care and focus on comfort, all of which are correlated with decreased hospital admissions and improved quality-of-life. While knowing a patient’s prognosis is crucial, studies consistently demonstrate the difficulties of establishing prognosis through clinical factors (tumor stage, performance status). The collective literature shows advanced diagnostic laboratory tests such as the blood-based VeriStrat test (prognostic for survival outcomes in NSCLC patients across treatments) help establish prognosis and guides treatment decisions and referrals to hospice for patients with poor prognosis. CONCLUSIONS: Knowledge and communication of prognosis is central to planning end-of life care and optimizing patient quality-of-life. By combining prognostic testing and clinical factors, physicians and practices can optimize end-of-life care and measurement and improvement of composite performance score.