The recent ACCC 31st National Oncology Conference featured 45-minute “Think Tanks,” supported by a grant from Genentech. The discussions focused on four hot topics in oncology: Lung Cancer Screening; the Healthcare Marketplace; Personalized Medicine; and Molecular Tumor Boards. This is the first in a four-part ACCCBuzz blog series recapping these discussions from Think Tank facilitator, Joseph Kim, MD, MPH, of MCM Education.
By Joseph Kim, MD, MPH, guest blogger
A small group Think Tank convened at the 2014 ACCC National Oncology Conference focused on key questions around lung cancer screening and how cancer programs are developing lung cancer screening programs. A question on everyone’s mind: Will low-dose CT (LDCT) scans for lung cancer screening be covered by Medicare?
The U.S. Preventive Services Task Force (USPSTF) lung cancer screening guidelines target asymptomatic adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit smoking within the past 15 years. The USPSTF is basing its recommendations on multiple studies including the NLST (National Lung Screening Trial) where 90% of the population was younger than 70 years, while MEDCAC (Medicare Evidence Development & Coverage Advisory Committee) is focusing on patients over the age of 65. The oncology community awaits MEDCAC’s final recommendation coming soon.
Think Tank participants acknowledged that an effective lung cancer screening program can be very cost effective. After all, lung cancer is the leading cause of cancer-related mortality in the U.S., with 159,000 deaths annually. Today, most patients are diagnosed with advanced disease, but effective screening would allow patients to get diagnosed and treated earlier in their disease. When LDCT was used for lung cancer screening, 55% to 85% of detected cancers were found at stage I.
Ensuring Appropriate Follow-Up
Are cancer programs in the community ready to handle the volume of new lung cancer patients? According to expert estimates, almost 9 million adults would be eligible for lung cancer screening. Although many hospitals may be prepared to handle the volume of performing LDCT scans and having radiologists interpret those studies, they are not adequately prepared to run and maintain a lung nodule clinic that will provide ongoing follow-up to patients who have a non-negative screening test. Some programs are implementing interdisciplinary teams, comprised of pulmonologists, surgeons, radiologists, oncologists, and nurses, who are working collectively to develop effective follow-up programs for patients who have a lung nodule. To ensure appropriate follow-up, these lung nodule clinics will need to maintain a strong level of communication with the patient’s primary care provider (PCP), but this may be especially challenging when patients who undergo a screening LDCT scan do not have an established PCP.
Smoking Cessation Remains Key
Think Tank participants also noted that some patients who undergo LDCT or who get diagnosed with lung cancer may not want to quit smoking. Therefore, cancer programs are making every effort to integrate robust smoking cessation interventions into the lung screening program so that every patient who is a smoker receives thorough counseling about the importance of smoking cessation.
Lung Cancer Navigators
To prepare for the increase of new lung cancer patients, many cancer programs in the community are investing in training or hiring new lung cancer navigators who can provide appropriate follow-up and care for patients.
Regardless of CMS’ coverage decision on LDCT for lung cancer screening, cancer programs in the community are developing and launching lung cancer screening programs because they believe that the evidence supports the value of having such programs in place. Think Tank participants agree that community hospitals recognize the key challenges they will face and are proactively planning ways of navigating around those barriers and obstacles. The Lung Cancer Alliance offers a wealth of resources and information about lung cancer screening.
Stay tuned for Think Tank #2 Discussing Healthcare Reform at #ACCC2014.
by Amanda Patton, ACCC Communications
Last week hundreds of cancer care providers gathered in San Diego for the 31st ACCC National Oncology Conference. Over two days, attendees joined in a range of dynamic sessions focused around two track themes: YOUR PATIENTS and YOUR PROGRAM.
A unifying message underlying this year’s conference sessions: Regardless of care setting, oncology care providers are facing the same challenges—new payment models, declining reimbursement, increasing competition, quality demands, rapidly evolving technology, and growing emphasis on patient engagement. To achieve the triple aim of improved quality, reduced cost, and enhanced services, providers will need to work together, collaboratively, across settings and service lines.
For those of you unable to be with us in San Diego, here are some key takeaways from each track.
Takeaways from YOUR PATIENTS TRACK:
- Truly patient-centered care requires conversations. For example, when a distress tool triggers a referral to financial assistance: Is the patient having trouble paying rent? Is the patient unable to pay for medications? Is the patient uninsured? Providers need to have conversations with patients to identify and meet these complex needs.
- Patients and families want to be active participants in treatment decision-making. And, they want a say in how our programs provide services, whether this means ensuring access to financial counselors, developing a patient transportation program, or creating a healing garden for reflection during treatments.
- All cancer programs have a responsibility to conduct community outreach—and we are doing this in a number of innovative ways, leveraging our community resources to reach at-risk and under-served populations.
- Proactive patient education provided before the start of treatment can help improve care and patient adherence to treatment recommendations.
- Patient engagement is key to patient-centered care. This requires on-going conversations between patients and their care providers. Patient portals are an emerging tool with potential to improve engagement and, under Meaningful Use, cancer programs will be required to use them.
- Cancer programs need to find ways to make communication easier for patients—whether it’s through an innovative symptom management clinic, patient advisory councils, patient portals, or other venues.
Takeaways from YOUR PROGRAM TRACK:
- The market place is in a state of flux—hospitals acquiring physician practices; practices coming together to strengthen their bargaining power with payers, while remaining autonomous. No matter what the practice setting, physicians and hospitals will need to work together to meet the growing needs of our cancer patients.
- Patient-centered care is not only a requirement for accreditation; it is the right thing to do for our patients!
- The oncology community is exploring a number of new care models. For example, Oncology Medical Home Models that put the patient front and center. This model is accessible to practices of all sizes. Requirements: being innovative and willing to change—tools are available to help.
- The most successful cancer programs have access to and actively mine data to identify areas for improvement and marketplace differentiators.
- With the growing demand for services and a shrinking workforce, the oncology community will need to explore ways to partner with primary care providers to meet the needs of cancer patients.
Stay tuned for additional session highlights from the ACCC 31st National Oncology Conference.
By Amanda Patton, ACCC Communications
ACCCBuzz is in San Diego this week for the ACCC 31st National Oncology Conference.
On Wednesday, at ACCC’s Financial Advocacy Network Pre-Conference, financial advocates from cancer programs around the country gathered for a one-day session focused on challenges and solutions to helping patients with issues around the costs of care.
Increasingly, the term “financial toxicity” is being used to recognize a potentially devastating side effect of cancer—the financial burden on patients and their families related to the cost of their care.
In 2012, the U.S. spent close to $3 trillion on healthcare, speaker Mark Rukavina, MBA, told attendees. Of this, $328 billion was estimated to have been paid out of pocket (for both uninsured and insured consumers). “We don’t have good cost containment strategies in place,” Rukavina said. As a result, people face out of pocket costs beyond their budgets and are exhausting their savings.
“One of the most troubling effects of financial toxicity is its impact on patients’ care seeking behavior,” he said.
Without question, the last challenge cancer patients need to face is the double whammy of serious health issues and serious financial issues.
Cancer care providers today are often on the front lines, helping patients and their families with financial issues surrounding the diagnosis and treatment of cancer. As ACCC’s 2014 Trends in Cancer Programs survey reveals, 90 percent of respondents report offering financial assistance services to patients, and 84 percent report having a financial specialist on staff.
Key session takeaways for oncology financial advocates include:
- Financial advocates need to know their place in the revenue cycle—barriers can crop up anywhere along the line.
- All patients should be screened for financial issues—coverage and financial assistance needs.
- Conversations about costs should take place early on in the care process.
- A lot of work needs to be done to educate newly insured patients about coverage they are purchasing through the insurance Marketplaces, including assistance in understanding health insurance terminology. For example, many newly insured consumers may not understand the meaning of terms such as “premium,” “deductible,” “co-payment,” and “co-insurance.”
- Metrics are key. Financial advocates should:
-Track out-of-pocket coverage metrics
-Measure results of their work and communicate results internally both to justify the position and show the value of the financial advocate services
-Practice continual learning, staying educated about changes in Medicare, state laws, ACA coverage, and more.
Stay tuned for upcoming ACCC Financial Advocacy Network regional meetings November 6 in Schaumburg, Illinois, and December 9 in Seattle, Washington. Find more resources for financial advocates at www.accc-cancer.org/financialadvocacy.
By Matt Farber, MA, Director, Provider Economics & Public Policy, ACCC
On Sept. 30, the Centers for Medicare & Medicaid Services (CMS) released the first round of Open Payments data to the public. The Open Payments program, which was mandated by a section of the Affordable Care Act (ACA) known as the Sunshine Act, requires drug and device manufacturers to report any payments or transfers of value – such as money for research activities, speaking fees, meals and travel – to physicians and teaching hospitals.
The recently released data is based on five months of payment reports, collected from August through December 2013. CMS continues to collect payment information this year and reporting on all 2014 expenditures is expected sometime next summer.
CMS provided a relatively short window (45 days) during which physicians could register and log in to the Open Payments system, check the accuracy of data reports and, if necessary, dispute any reports that they did not believe to be accurate. Unfortunately, most physicians did not review the reports before public release of the data. In fact, technical glitches with the Open Payments system—approximately one-third of the payment reports had “intermingled data”—caused CMS to shut the system down for several days during the physician data review window. In the face of these technical difficulties, both the American Medical Association and PhRMA urged CMS to delay the public release of the Open Payments data but, as we’ve seen, CMS held firm on the Sept. 30 release date.
What Does This Mean for Providers?
First, ACCC recommends that all physicians log in to the Open Payments system, and ensure that all data reports are accurate. CMS is reporting that 4.4 million payments were made during the second half of 2013, totaling $3.5 billion attributable to 546,000 individual practitioners and 1,360 teaching hospitals. Of the 546,000 individuals, only 26,000 (less than 5 percent) registered in the system, the first necessary step to verifying data reports. In addition, CMS suppressed 40 percent of the Open Payments records released because the agency could not reconcile differences in provider names and numbers reported by industry. CMS expects these data to be corrected in time for the next reporting period.
A yet-to-be resolved issue is what will happen with these data. First, it is important to note, as CMS has, that these payments do not necessarily signal wrongdoing; physicians have relationships with industry for a host of reasons, some of which are critical to advancements in innovative medical therapies and patient care. This glimpse into payments is just that: a limited window into billions of dollars in industry spending. ACCC has also long stated that we do not believe that the Open Payments data will greatly impact patients’ choice of providers. There will certainly be outliers, physicians who have a high dollar figure associated with them (not counting those with research money attributed to them) who may draw the attention of the media. This may be especially true if the same physicians appear with a high Medicare payment figure from CMS’ earlier release of data on Medicare payments to physicians. But for a majority of providers, we predict little impact.
Moreover, ACCC hopes that Open Payments data reporting will not have unintended consequences, such as a chilling effect on participation in clinical research. For example, if providers do not want their name to appear in the data reports, they may no longer participate in industry-sponsored trials, nor will they accept certain publications from industry, important activities to advancements in clinical research and cancer care. In addition, if CMS finalizes its proposed rule on the 2015 Medicare Physician Fee Schedule that included elimination of the exemption for payments made to speakers at CME events, the sunshine reporting may have a negative impact on participation in certain CME programming.
If you are a physician or if you work with physicians who have not yet registered in the system, we highly encourage registering today to ensure the accuracy of the reporting. For more information, click here.
Prepare to be inspired.
Richard Rossi, the keynote speaker at ACCC’s 31st National Oncology Conference in San Diego, Calif., October 8-10, 2014, will introduce meeting attendees to some of the country’s most gifted teenage researchers who are already changing the future of cancer care.
“With all negative news in healthcare, with all the stress and challenges as a cancer care professional, this will be a wonderful opportunity to hear how young people have fundamentally changed the future of medical care by their interventions,” said Rossi. He co-founded the National Academy of Future Physicians and Medical Scientists, an educational enrichment organization that honors, inspires, and motivates the nation’s most promising future physicians.
“Jack Andracka. He’s 17, but when he was 14 and sitting in his science class, he imagined a way to diagnose pancreatic cancer in stage I,” said Rossi.
According to Jack’s Wikipedia entry, the idea for his pancreatic cancer test came to him while he was in high-school biology class, drawing on the class lesson about antibodies and an article on analytical methods using carbon nanotubes he was surreptitiously reading in class at the time. Afterward, he followed up with more research using Google Search on nanotubes and cancer biochemistry, aided by free online scientific journals.
“At age 15 he contacted 200 professors asking for lab space to test his thesis. One hundred and ninety-nine turned him down,” said Rossi. Finally, he received a positive reply from Anirban Maitra, Professor of Pathology, Oncology, and Chemical and Biomolecular Engineering at Johns Hopkins School of Medicine.
The result of his project was a new dipstick-type diagnostic test for pancreatic cancer using a novel paper sensor, similar to that of the test strip for diabetes. This strip tests for the level of mesothelin, a soluble cancer biomarker, to determine whether a patient has early-stage pancreatic cancer. The test is over 90 percent accurate in detecting the presence of mesothelin.
“Jack is not an anomaly,” said Rossi. “The good news is that there are a whole bunch of young people making a huge difference in cancer research.”
And cancer research is not the only area of oncology that’s engaging tomorrow’s leaders.
Some ACCC-member cancer programs are finding innovative ways to connect with the next generation of oncology professionals–from mentoring future oncology nurses to offering internship opportunities to tapping into the energy and enthusiasm of young volunteers in the community.
Stay tuned to ACCCBuzz for highlight’s from Rossi’s keynote talk, “The Good News About the Future of Medicine,” next Friday, October 10, 2014.
Rossi currently serves as president and executive director of the National Academy of Future Physicians and Medical Scientists. Its mission is to identify, encourage, and mentor students who wish to devote their lives to the service of humanity as physicians, medical scientists, technologists, engineers and mathematicians.
It’s not too late to attend the ACCC National Oncology Conference, learn more here.
by Don Jewler, Guest Blogger
For CoC surveyor William Laffey, MBA, the top benefit is that cancer programs gain access to data that they could not otherwise get about their own program. “They also gain access to comparative data to help them improve quality and understand why patients are coming to them and which patients are not. You can’t get access to the National Cancer Data Base unless you are accredited,” said Laffey, who will speak at ACCC’s upcoming 31st National Oncology Conference in San Diego, on October 9, 2014.
One set of data is on “Class 00” patients, those who come to a cancer program for diagnosis but never come back for treatment. Through analysis of the data on these patients, the cancer program can find out where they went, what treatment they had at that other facility, and, in some cases, even the referring physician.
“I’ve run into situations where large numbers of these Class 00 patients all went to a competing hospital,” said Laffey. “Their first course of treatment was for surgery. As I dug deeper, I found that most surgeries were for breast cancer. This hospital needed to improve its breast cancer surgery to keep these patients.”
When cancer programs peel back the onion, or in this case the data, they can determine exact areas to improve, including surgery, equipment, and scheduling, and they can dramatically improve their bottom line.
The National Cancer Data Base (NCDB), which is available only to CoC-accredited programs, has 15 to 20 different variables that can be compared on its 30 million patients.
Susan Rubin, MPH, of the Commission on Cancer, will join William Laffey at the ACCC National Oncology Conference. Rubin will examine key marketing strategies that cancer programs can use to maximize the value of their accreditation.
“Do you advertise the fact that your cancer program is accredited? Do you put the CoC seal on your newsletter?” Rubin asked. “It’s good to do so.”
Rubin noted that some cancer programs that go through the accreditation process do not publicize their accreditation. “Some staff in the hospital don’t even know the program is accredited,” she said. “Go out and explain to your staff the value of accreditation, their access to the National Cancer Data Base and to the Rapid Quality Reporting System.”
The Rapid Quality Reporting System (RQRS) is a reporting and quality improvement tool which provides real-clinical-time assessment of hospital-level adherence to National Quality Forum-endorsed quality of cancer care measures for breast and colorectal cancers.
If you want more practical advice on how to use the information that CoC accreditation opens up to your cancer program as well as tips on how to market that accreditation, join Laffey and Rubin at ACCC’s 31st National Oncology Conference in San Diego, on October 9, 2014.
William Laffey, MBA is the system vice president of oncology for Presence Health in Chicago, Ill. He provides a program administrator perspective to the Commission on Cancer survey process. Susan Rubin, MPH, is manager, Accreditation Program, at the Commission on Cancer.
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 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.
This is year five of the survey, which is a joint project between ACCC and Lilly Oncology. More than 110 ACCC-member cancer programs participated in this year’s survey. Learn more here.
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.