By Becky L. DeKay, MBA, President ACCC
The Association of Community Cancer Centers (ACCC) has just released its 2014 Trends in Cancer Programs survey results, and our membership revealed what matters to them most—delivering quality, patient-centered care. ACCC’s annual survey provides insight on the top issues facing cancer programs today, from clinical trial accrual, to expanding use of oral oncolytics, to providing financial advocacy services, and much more.
My presidential theme during my 2014-2015 term is quality cancer care, and I firmly believe that quality is a journey, not a destination. With this in mind, an analysis of these survey results reflects how our members are continuously striving to deliver quality care with a variety of forward-thinking solutions.
One compelling new trend among cancer programs—an increasing number are proactively developing their own guidelines to help measure and track the quality of care provided, rather than waiting to be told what to do by payers. This determination to anticipate the changing healthcare landscape and to grow is encouraging; especially since only 28% of respondents reported that payers currently require quality measures.
At Feist-Weiller Cancer Center we have participated in ASCO’s Quality Oncology Practice Initiative (QOPI) to gauge our quality in clinical care, and have done very well. We also have patient satisfaction surveys, and usually our scores are high. What keeps me up at night, though, is that we are unsure as to how best present this data to our various stakeholders who define quality care in very different ways.
For example, while “trastuzumab for patients with AJCC stage I (T1c) to III HER-2/neu positive breast cancer” may make sense to clinicians—payers and patients may not understand the clinical decision making for an expensive drug that is not without side effects. And when the patient spends more than 30 minutes in an exam room, many payers on the “judging” side (or clerical staff entering the data reported) won’t know that this reflects the fact that the patient needed more time with the physician team before making an informed decision and not that she was just waiting for a physician to arrive.
One thing all stakeholders agree on is the importance of patient-centered care. Our patients’ needs are not solely medical, a fact many cancer programs have started to address. In ACCC’s 2014 Trends in Cancer Programs survey, an increasing number of cancer programs report that they are stepping up their efforts to ensure that they are ready for the American College of Surgeons’ Commission on Cancer (CoC) standards that go into effect in 2015, including those related to palliative care, clinical trials, patient navigation, cancer survivorship, and genetic counseling. The survey also suggests that patient-centered care is driving growth in the number of supportive services being offered, including integrative and complementary therapies. This year’s survey shows that the patient-centered field of financial advocacy is thriving, with 90% of survey respondents offering financial assistance services, and 84% reporting that they have “financial specialists” on staff.
As ACCC continues to solicit feedback from its members, I hope that you will find this survey a useful resource to comprehensively evaluate your organization’s performance.
Becky L. DeKay, MBA, is ACCC President (2014-2015) and director of oncology services at Feist-Weiller Cancer Center in Shreveport, La.
By Don Jewler, Guest Blogger
In a perfect world each patient who has recently completed cancer-directed therapy should receive a survivorship care plan that clearly summarizes his or her treatment and provides direction on what to expect in the next several weeks, months, and years of their life to come. That survivorship plan should be available in print form as well as easily accessible electronically on a patient web portal.
Oncology Specialists, SC, in Park Ridge, Ill., did exactly that. What’s more, they developed their survivorship care plan with the idea of incorporating many of the information points that are already collected within the patient’s electronic medical record (EMR) that essentially self-populates into the plan. The plan provides a treatment summary, including side effects, as well as health maintenance issues and the impact of cancer diagnosis on the well-being of family members.
Oncology Specialists, SC, will be honored with a 2014 ACCC Innovator Award for its EMR-driven approach to survivorship care plans.
“The impetus for development of the survivorship plan was a mandated change in the Commission on Cancer standards,” said Mary Beth Mardjetko, RN, MN, administrative director.
Standard 3.3 (a 2012 standard that must be phased in for 2015) states that the cancer committee must develop and implement “a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment.”
Initially, after reading Commission on Cancer (CoC) requirements, Mardjetko and others in the oncology practice were worried. With limited resources and time, how could they put together a survivorship plan for all their patients?
“We saw 40-page survivorship plans. We knew these would not be realistic in our practice. So, a small group consisting of a physician, three nurses, and myself looked at the CoC requirements,” said Mardjetko. “We decided to use the template function of the EMR and build a generic survivorship plan that would be individualized for each patient using information that would pull directly into the note. We developed a four- to six-page survivorship plan with the CoC standards as the guide.”
Those standard elements include a treatment summary, drug names, doses, side effects, and names of all physicians and supportive care personnel involved. A treatment plan for years one to five is provided, as well as long-term outlook and recommendations, such as genetic testing for first-degree relatives.
Since nurses and physicians constantly update the EMR, the survivorship plan is dynamic and versatile. It can easily be sent to the primary care physician or other physicians involved in that patient’s care.
“The most wonderful part was how grateful patients were for learning what was to come next—what they could expect now and in the future,” said Mardjetko. “Physicians and nurses found the experience wonderful, too, as they went over the survivorship plan with patients and provided closure at the end of treatment.”
The next step is for Oncology Specialists, SC, to work out a survivorship plan for patients who are metastatic or on oral therapies.
“This is still a work in progress,” said Mardjetko.
Want to learn more? Join us at ACCC’s upcoming 31st National Oncology Conference in San Diego, October 8-10. Sigrun Hallmeyer, MD, medical director, Cancer Survivorship Program, Oncology Specialists, SC, Advocate Lutheran General Hospital, will provide more details. And check out a video about the survivorship plan here.
ACCC members will recognize the byline of guest blogger, Don Jewler, former ACCC Communications Director. We coaxed Don out of retirement to contribute to ACCCBuzz.
by Don Jewler, Guest Blogger
In case you didn’t notice, the cancer clinical trials infrastructure across the country is changing.
In August 2014 the National Cancer Institute (NCI) awarded 53 new five-year grants to researchers across the country to conduct multi-site cancer clinical trials and cancer care delivery research studies in their communities. The grants were awarded under the NCI Community Oncology Research Program (NCORP), a national network of investigators, cancer care providers, academic institutions, and other organizations that provide care to diverse populations in community-based healthcare practices across the United States. The program funding is $93 million a year for five years.
“I’m cautiously optimistic,” said Nicholas J. Petrelli, MD, FACS, who will be presented with ACCC’s 2014 Clinical Research Award at the upcoming 31st National Oncology Conference, in San Diego Calif., October 8-10, 2014. “With developments in genomics and in the infrastructure of NCORP, perhaps we can make a dent in overall survival in many of the solid tumors, beyond two- and three- and four-month survival, especially in the top five cancers we see in this country.”
Dr. Petrelli is also optimistic in the area of cancer prevention. “We spend so much effort and so much money on advanced disease and even early-state disease that we are long-overdue for a paradigm shift towards prevention. Perhaps as we enter into the world of proteomics and genomics, we will be able to do a better job at preventing the top cancers. I’m hoping that NCORP will move us forward on this front.”
Thirty-four NCORP Community Sites and 12 Minority/Underserved Community Sites will implement the latest, most scientifically advanced clinical research designed and led by NCORP. These clinical trials will bring added opportunity to test new technologies and strategies to fight cancer. They will also enable research on how cancer care is delivered in today’s changing healthcare environment, all with an eye toward improving outcomes and reducing disparities of care.
NCORP replaces two previous NCI community-based clinical research programs: the NCI Community Clinical Oncology Program (CCOP, made up of the Community Clinical Oncology Programs, Minority-Based Clinical Oncology Programs, and Research Bases) and the NCI Community Cancer Centers Program (NCCCP). The new program builds on the strengths of the previous programs and aims to better address the most pressing issues affecting the conduct and delivery of cancer care in communities across the nation.
With the 34 NCORP Community Sites and a realignment of the cooperative groups, Dr. Petrelli hopes to see a rise in the annual 4 percent national accrual average of adults on clinical trials.
A major sticking point remains: adequate funding.
“We’re running on a quarter tank of gas with NCORP, and that’s not going to get us too far,” said Dr. Petrelli. “There’s got to be a change in funding at the federal level in order for the program to be successful; otherwise, we are spinning our wheels.” What’s more, he noted, we will have to find a way for hospitals not funded by NCORP to continue their infrastructure of clinical trials.
Dr. Petrelli expressed hope that resources will improve as NCORP’s infrastructure begins to grow.
As for the opportunities ahead for clinical cancer research, Dr. Petrelli singled out his top two. “First, we need to evaluate the costs of what we are doing,” he said. “We need to evaluate patients as they go through treatment—how often they get imaged or blood drawn, for example. We need to take a hard look and be very practical in the management of costs. Second, genomics, which will allow us to move faster with regard to overall survival,” as genomic data helps us improve cancer prevention, early detection, diagnosis, and treatment.
Dr. Petrelli is the Bank of America endowed medical director of Christiana Care’s Helen F. Graham Cancer Center & Research Institute in Newark, Delaware. The institution earned a five-year grant from NCORP to bring leading-edge cancer screenings, prevention, control, treatment, and imaging research trials to more people in the places closest to where they live.
Hear more from oncology thought-leaders at the ACCC National Oncology Conference, Oct. 8-10, 2014, in San Diego. Learn more here.
ACCC members will recognize the byline of guest blogger, Don Jewler, former ACCC Communications Director. We coaxed Don out of retirement to contribute to ACCCBuzz.
by Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC
The US Pharmacopeial Convention (USP) recently released draft guidance on the containment of hazardous drugs (HDs) to “as low as reasonably achievable” in order to ensure the safety of personnel handling these drugs. According to the Centers for Disease Control (CDC), about 8 million people every year could be exposed to HDs, so USP developed Chapter 800 to protect this population in the transporting, receiving, compounding, and dispensing of these products. While ACCC’s Oncology Pharmacy Education Network (OPEN) supports USP’s aim to increase personnel safety, we remain concerned that implementation of these proposed standards would result in reduced access to care for patients with cancer.
USP is a scientific nonprofit organization that sets standards for the identity, strength, quality, and purity of medicines, food ingredients, and dietary supplements manufactured, distributed and consumed worldwide.
The guidelines outlined in the proposed Chapter 800 call for any facility compounding or mixing HDs, no matter how infrequently, to undertake a series of precautions, including separate storage locations for sterile and non-sterile drugs. For many ACCC members, adherence to Chapter 800 would not only pose a major financial concern, it would present a challenge in terms of having enough physical space to comply with guidelines—especially for those in urban settings or with facilities located within a cancer center. Ultimately, if the chapter is adopted, it could cause some cancer facilities to either stop offering mixing services for their patients, or in extreme cases, to close altogether.
However, it is important to understand that USP Chapter 800 presents guidelines—states individually adopt Chapter 800 for these to become mandatory. Still, even if a state has already adopted USP Chapter 795 and/or Chapter 797, it does not preclude that state from adopting Chapter 800, as well. This is because Chapter 800 addresses containment matters and is designed to build on 795 and 797, not replace them.
ACCC’s Oncology Pharmacy Education Network (OPEN) and the Oncology State Society Network (OSSN) recently submitted comments to USP on proposed Chapter 800. In addition, ACCC joined with representatives from other cancer organizations in a group letter to USP expressing common concerns regarding proposed Chapter 800.
ACCC will continue to keep members informed on this issue.
By Matt Farber, MA, Director of Provider Economics & Public Policy, ACCC
On July 3, 2014, the Centers for Medicare & Medicaid Services (CMS) released the 2015 proposed rules for the Hospital Outpatient Prospective Payment System (OPPS) and the Physician Fee Schedule (PFS), and ACCC is busy poring through the documents in order to get the most pertinent information out to our members as soon as possible. Look for complete summaries of both rules from ACCC shortly, and ACCC members be sure to dial in to our conference call on the proposed rules on Wednesday, July 23rd at 2 pm ET.
At first glance, we can say the 2015 proposed rules do not appear to include as many drastic changes as in previous years.
For example, the proposed 2014 OPPS rule contained proposals to collapse all E&M codes, package drug administration services, and other packaging proposals, which–had they all been implemented—would have meant significant changes for oncology. In the end, while CMS did finalize the proposal to collapse E&M codes, the agency did not finalize all of the packaging proposals. Now, for 2015, the agency is proposing to increase packaging and composite APCs; however, drug administration is not included in that list. That being said, we know that CMS still wants to study drug administration, so we do not believe that changes to that area are necessarily off the table.
Another interesting proposal for 2015 has to do with off-campus departments of hospital outpatient departments (HOPDs). Last year, CMS stated that it wanted to collect data to determine if payments made to “off-campus facilities,” often practices that have recently been purchased by a hospital and converted to a HOPD, are justified at different rates. For 2015, CMS is proposing to require that all services rendered in these off-campus departments be billed with a modifier, so that the agency can study the issue and potentially make changes in the future.
Finally, in the 2015 proposed OPPS rule, drugs are still scheduled to be reimbursed at ASP+6% in the HOPD. So it appears that the ACCC’s years of hard work on this issue have continued to pay off.
On the Physician Fee Schedule side, there is the continuing issue of the sustainable growth rate (SGR)—but this is no surprise. Once again, under this flawed formula, there is a scheduled cut to physician reimbursement of 21%. And once again, this most likely will not go into effect, as Congress will step in later this year or early next year with yet another (hopefully long-term!) “doc fix.” Under the proposed PFS, medical oncology is slated to receive a 1% increase, which is always better than a negative number. On the other hand, radiation oncology would not fare as well, with larger cuts scheduled for radiation oncology and radiology.
While at first look, it may appear that the 2015 proposed rules put forth less onerous issues than in prior years, ACCC will still be submitting comments to CMS with our concerns, and we encourage you to submit comments as well. Once ACCC’s comments are completed, ACCC will post them in the Advocacy section of the website, and members can use these as a template, if desired. CMS is accepting comments on these rules until Sept. 2, 2014.
Meanwhile, ACCC encourages all members to join us with your questions on the July 23 members-only conference call. For more information, please contact Matt Farber at firstname.lastname@example.org.
By Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC
Implementation of the Affordable Care Act (ACA) is bringing many changes to the healthcare system, including the establishment of health insurance exchanges and new requirements for insurance coverage.
Health insurance exchanges (also known as health insurance marketplaces) provide an option for patients to purchase health insurance outside of employer-based plans and are a step toward the goal of universal coverage. However, because all plans offered through an exchange must meet minimum health benefits and satisfy other insurance reforms, such as a cap on annual benefits and coverage for young adults, individual plan premiums on the exchanges are often more expensive than patients expect. This could lead–and in some cases, has already led–to missed premium payments.
In the event of a lapsed premium payment for individuals enrolled in a federally facilitated exchange (FFE) plan, the ACA gives patients 90 days to become current on any past payments before insurance coverage is terminated. The ACA replaces all existing state laws with the 90 day rule. The rule applies to all consumers, in all states, who purchase subsidized coverage through the FFE health insurance marketplace.
How the 90-Day Rule Works
Here’s how the 90-day grace period works. After the first premium is made, patients have 90 days to pay the next premium. If the patient doesn’t pay the premium for the second month, the insurer can hold all claims. At the end of the third month, if the patient still has not paid, the insurer may terminate the policy.
Unfortunately, there is one wrinkle in the 90-day rule that is concerning for providers. This issue only applies to those individuals who receive tax subsidies to purchase insurance through the FFE insurance marketplace. In this instance, if a consumer still fails to make a payment after 90 days and his or her coverage is dropped, insurers are not required to pay for claims incurred during the last 60 days of the grace period. This means that if coverage for these patients is dropped for nonpayment, physicians must work directly with the patients to collect payments for the balance incurred during days 31-90 of the grace period.
While this issue only applies to individuals who receive tax subsidies to purchase insurance through the federally facilitated insurance exchanges, providers need to know that patients’ insurance cards will not include information on whether or not the patient is receiving subsidies. Claims unpaid the 31st through the 90th day may be pended by the insurer. If the enrollee never pays his or her share, the claim is not payable by the insurer.
During a recent House Energy & Commerce Oversight and Investigations Subcommittee hearing, insurers were asked about health insurance marketplace enrollment and premium payment by enrollees. Representative Michael Burgess (R-TX) and other subcommittee members expressed concern over the 90-day grace period and the chilling effect it may have on provider participation in exchange plans. Insurance company executives testifying at the hearing assured the subcommittee that adequate systems are in place to give physicians the ability to determine patient payment and eligibility status. Industry representatives said call centers, and in some instances online applications, are available for premium payment verification. However, premium status policies vary by company and so providers and their staff are left with a complex process for determining a patient’s status. At the conclusion of the hearing, the Oversight and Investigations Subcommittee remained concerned that this information is not readily available to healthcare providers who might ultimately be left unreimbursed for care already provided.
ACCC agrees with the concerns expressed by House Energy and Commerce Subcommittee members and urges Congress and the Administration to work together to require more easily accessible and real-time patient status data to be available to providers. ACCC has submitted a letter to the Administration about this issue and continues to work with members of Congress to raise the volume. We will keep members posted on any developments on the 90-day grace period.
By Matt Farber, Director of Provider Economics & Public Policy, ACCC
Last week’s Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) low confidence vote for annual low-dose computed tomography (LDCT) screening for patients at high-risk for lung cancer came as quite a surprise. The Medicare national coverage determination panel’s vote is disappointing in light of the evidence of mortality benefit demonstrated in the National Lung Screening Trial (NLST) and the U.S. Preventive Services Task Force (USPSTF) December 2013 grade “B” recommendation.
The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The recommendation states that screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. While the Affordable Care Act (ACA) requires private payers to cover services rated highly by the USPSTF, including LDCT, beginning Jan. 1, 2015, the ACA does not mandate the same coverage for Medicare. So providers are awaiting a Medicare national coverage determination (NCD).
ACCC member cancer programs have been following the issue of low-dose CT screening for lung cancer closely. Many community cancer programs have developed or are in the process of developing evidence-based lung screening programs in response to the evidence presented in the NLST study and the USPSTF final recommendation.
ACCC recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) urging full coverage of lung screening for individuals at high risk.
According to media reports, among the MEDCAC panel’s main concerns were the high false-positive rate of CT screening, the potential for LDCT screening to expand beyond the intended high-risk population, and quality issues for scans with low radiation dose. The issues raised by the panel highlight some of the real-world challenges encountered when translating research into practice.
It’s important to keep in mind that Medicare does not have to follow the recommendations of the MEDCAC, so the panel’s recommendation is not the end of the story for LDCT screening coverage. In fact, even if Medicare does agree with the MEDCAC, the public will still have the opportunity to comment on the national coverage decision before a final version is released.
So, while this recommendation is certainly disappointing, it is not the end of the advocacy efforts for ACCC and our members. Stay tuned for the proposed NCD later this year, and more from ACCC. The proposed national coverage determination is due in mid-November, and the public will have 30 days to comment.
ACCC will keep its members updated as this policy evolves. If you have questions or concerns, please contact Matt Farber at email@example.com.
In April, ACCC held its 40th Annual National Meeting, with a focus on policy, economics, and business. The session on “Strategies for Growth in Cancer Care Delivery,” with Sg2 Vice President Trever Burgon, PhD, was standing room only. ACCCBuzz invited Dr. Burgon to share some key takeaways from his talk. Read on and find out why the term “indispensable” is the way you want patients and payers to describe your cancer program.
Let’s start with a provocative statement: There is no service line more important to your hospital, practice or health system’s future competitive position than cancer services. Here are three areas of evidence to support this claim:
1. Growing demand – An aging population and expanding treatment options will drive strong demand for cancer services. At the recent ACCC 40th Annual National Meeting in Arlington, Va., I shared data from Sg2’s Impact of Change® forecast model, which projects demand for healthcare services over the next decade. Much of this growth will happen in the outpatient setting, in fact, Sg2 forecasts stronger outpatient growth for cancer than for any other service line. Nationally, we anticipate that demand for ambulatory cancer care will increase 15% over the next five years and 31% over the coming decade. Demand growth will be softer on the inpatient side, increasing only 3% over the next decade. There is an important nuance in these inpatient numbers. Many inpatient surgical procedures will see strong growth of +9% over the next 10 years, while non-surgical admissions are expected to fall by 5%. This expected decline will be the result of improved patient management in the ambulatory setting and expanded access to appropriate palliative and end-of-life care which will reduce avoidable hospitalizations. Meeting this demand will require hospitals and health systems to develop and expand strong systems of care that coordinate services across the care continuum, from screening and diagnosis to outpatient and inpatient treatments through survivorship and end-of-life care.
2. Changing economics – Per person, cancer is the most expensive disease to treat in the U.S. For providers and health systems, cancer care represents an important source of revenue that helps subsidize other care delivery services. At the same time, spending on cancer is increasingly coming under the scrutiny of public and private payers looking to control healthcare spending costs. As we heard multiple times at the recent ACCC meeting, various new payment reforms, including robust benefits management, bundled payments, and narrow networks, all have the potential to materially impact cancer services. Successfully navigating these changing economic structures has the potential to impact the entire enterprise.
3. Connecting with patients and families – Cancer occupies a unique and important part of our healthcare landscape. It is a terrifying disease that will impact virtually each one of your patients and prospective patients either through a personal diagnosis or that of a loved one. Meeting the needs of these patients and their families with seamlessly coordinated, patient-focused services that span the care continuum represents a powerful opportunity to engage and care for these consumers over their lifetime. Guiding a patient from initial diagnosis to treatment, providing critical but under-reimbursed psychosocial support services, or ensuring that patients’ end-of-life treatment plans are aligned with their quality of life goals, can be some of the best opportunities to establish your program as the go-to place of care for all of a family’s healthcare needs. If you can provide this level of coordinated, patient-centered care for a complex disease like cancer, you can do it for any disease.
What must cancer programs do to position themselves for success in the face of growing demand, changing economics, and unique opportunities to connect with patients? Build a differentiated program that is indispensable to both patients and payers.
There are many ways to build this type of program and no two cancer programs will establish their indispensability in the same way. One area that will be consistent across all successful programs, however, will be a robust system of care that delivers value by ensuring patients and data flow seamlessly between the many providers and sites that span the cancer care continuum. At ACCC’s Annual National Meeting in April, we discussed a number of clinical opportunities for differentiation, including protocol-driven lung screening, easy-access one-day multidisciplinary clinics, and cancer-program-embedded outpatient palliative care services. In addition, we examined a number of oncology-specific bundled payment and accountable care pilots that progressive organizations are using to differentiate themselves with payers.
There are not enough resources to build every clinical program you would like, and not all of the new payment pilots will be successful and scalable. But these types of investments and innovations will be the key to making your cancer program indispensable in your market. And it will be these indispensable programs that succeed, to the benefit of your hospital, practice, or health system and more importantly, your patients.
by Amanda Patton, Manager, Communications, ACCC
Becky L. DeKay, MBA, became President of the Association of Community Cancer Centers (ACCC) on April 2, during the ACCC 40th Annual National Meeting. Ms. DeKay is Director of Oncology Services at the Feist-Weiller Cancer Center in Shreveport, Louisiana. In a Q&A interview with ACCCBuzz, she talks about what drew her to oncology and why she’s chosen “Quality” as the theme for her ACCC presidency.
ACCCBuzz: Can you tell us how you first became involved in the oncology field, a bit about how your career has evolved, and how you were first introduced to ACCC?
Ms. DeKay: My career has taken a circuitous route. I began in marketing, research actually, and joined a private hospital in 1990 as Director of Marketing. I then moved to Medical Staff Development. In 2001 I stopped working when our son, Chris, was diagnosed with Burkitt’s lymphoma, B-cell leukemia, Stage 4. I am happy to say that, thanks to St. Jude’s Children’s Research Hospital, he is 13 years cancer free. This episode ignited my desire to help others who are living with cancer. Before joining Feist-Weiller Cancer Center, I had chaired one of their fundraisers, Life Savers Ball. Through this experience, I learned more about FWCC, how they help patients, and the wonderful care they provide. After the event, the medical director at the time, Jonathan Glass, MD, graciously offered me a role in the management of FWCC. Ever since, I’ve been Director of Oncology Services at FWCC, LSU Health Shreveport.
ACCCBuzz: What would you like to accomplish during your term as ACCC President?
Ms. DeKay: Immediate Past President, Virginia Vaitones, MSW, OSW-C, highlighted the multidisciplinary team that takes care of the patient. We all know oncology care today takes an enormous amount of coordination and interaction. I hope, during my term as president, to focus this team on quality in cancer care. We all practice high-quality medicine, but how do we communicate that? How can we best demonstrate, replicate, and share our quality practices with other stakeholders—patients, providers, and payers—so they can understand and appreciate the work we do.
ACCCBuzz: What do you see as the most significant challenges facing the oncology community today?
Ms. DeKay: The pressure from the payers—private and government—is increasing daily. Rules change, reimbursement decreases, new therapies cost more money…all of these things create tension in the system. In the middle are our patients who are extremely sick and in the fight for their lives—physically, literally, emotionally. How can we help these most vulnerable patients while staying “alive” in this business?
ACCCBuzz: How might ACCC help its membership in meeting these challenges?
Ms. DeKay: ACCC can help the membership by continuing to provide the quality advocacy and education that has become the stalwart strength the members rely on. All of us are out in our communities every day. We must have a consistent message to share with our elected officials—on the state and national level—and speak up with a unified voice for the patients living with cancer. If that voice is loud enough, eventually it will be heard.
ACCCBuzz: You will be focusing on quality as the theme of your presidency. In this time of healthcare reform, this is a key issue. What role do you see for ACCC supporting its membership in the delivery of quality care?
Ms. DeKay: Quality is a key issue and it should be. I wanted to focus on quality in cancer care as my theme so that our cancer community can begin to define the measures we need to share rather than a payer group—any payer group—defining them for us. ACCC members are on the front lines of cancer care in communities across the country. We know what makes sense, what data can be collected, and which benchmarks should be reviewed. ACCC can help facilitate this discussion and work with its membership on how best to demonstrate and communicate quality. We need to be able to communicate the same message to various stakeholders—including those who are just learning the language of cancer. The quality is there…we just need to prove it!
by Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC
National Cancer Institute’s (NCI’s) recent announcement that two community-based research networks, the Community Clinical Oncology Program (CCOP) and the NCI Community Cancer Centers Program (NCCCP), would be combined under the NCI Community Oncology Research Program (NCORP), raised concern and confusion about future clinical trial funding for community-based programs. In a blog post last week, ACCC expressed concern about a reduction in clinical trials and a possible gap in funding.
The NCI announcement about the change states that the new NCORP will have fewer investigators and “will be comprised of some of the sites formerly funded through the CCOPs, MB-CCOPs, and NCCCP, as well as new grantee institutions….”
NCI Director Harold Varmus has now released an open letter to the oncology community clarifying how this consolidation will impact clinical trial funding. The newly formed NCORP network will center on treatment and prevention-based clinical trials, as well as population-based studies and other research.
Dr. Varmus responded to concerns about maintenance of funding between the current round of annual CCOP awards (June 2014) and the start of the newly created NCORP (estimated to be August 2014), stating:
“With Fiscal Year 2014 budgets now in place, our grantees can be assured that NCI will fund all CCOPs at their current levels during this period. While this was always our intention, this has not been clearly communicated. Furthermore, currently funded investigators should continue the active, uninterrupted accrual of patients to new or ongoing clinical trials during this interval. As in the past, full funding for all research activities required to carry out approved studies will be provided.”
In addition, the letter states that programs not selected to receive funding under the new NCORP will receive assistance to ensure the smooth closeout of operations.
ACCC continues to monitor developments and will keep members updated as additional information is released.