Changes Coming to Commission on Cancer Standards

Posted in Cancer Care by ACCCBuzz on September 30, 2010

by Don Jewler, ACCC’s Director of Communications

At a well-attended conference session in St. Louis, Frederick Leslie Greene, MD, FACS, who serves on the Commission on Cancer (CoC) of the American College of Surgeons (ACoS) and served as the Chair of the Commission from 2004-2008, explained what lies ahead with cancer program requirements.

He outlined the major changes, which include the addition of continuum of care standards; additional focus on cancer committee leadership through expanded coordinator and CLP role; and a renewed focus on quality of care through performance metrics and quality improvement activities. In addition, he noted an increased emphasis on clinical trials and nursing education.

Most of the changes echoed our earlier blog by Luana Lamkin.

1) Standard 2.8: The standard and documentation have been changed to increase the percentage of cases presented annually at cancer conference (from 10 percent to 15 percent), to specify that 80 percent of the cases discussed involve planning the first course of treatment, and to include the discussion of site-specific prognostic indicators. A Commendation rating is given if 25 percent or more of the annual analytic caseload is discussed at conference annually

2) Standard 3.1: The standard has been changed to require abstracting by a cancer tumor registrar (CTR). The standard will be phased in over three years. After that time, abstracting by non CTRs is not permitted.

Additional standards:

1) The cancer committee, or other appropriate leadership body, works with the psychosocial representative to monitor the effectiveness of psychosocial activities on an annual basis. The activities and findings are documented in a Psychosocial Services Annual Summary Report presented to the cancer committee annually.

2) The cancer committee, or other appropriate leadership body, develops a process to implement and monitor dissemination of a comprehensive care summary and follow-up plan to cancer patients completing cancer treatment. The process is monitored, evaluated, and presented at least annually to the cancer committee, or other appropriate leadership body, and documented in minutes.

No changes in frequency of committee meetings or conference evaluations. No change in staff education requirements.

ACCC will keep members apprised of any and all changes.

No Need to Apologize for Maximizing Your Revenue

Posted in Cancer Care by ACCCBuzz on September 30, 2010

by Don Jewler, ACCC’s Director of Communications

I’m still in St. Louis on day two of ACCC’s National Oncology Economics Conference. Randy Farber, MSHA, president, Farber Consulting Group, gave attendees practical advice on ways to maximize their billing and collection efforts.

He began by almost apologizing for his topic.

“When we see the patients’ suffering, we don’t want to be hard-nosed about collecting. But the reality is that we are a business. The best thing we can do for our patients is to be here tomorrow to care for them. It’s vitally important to collect every penny due you.”

He spoke first about a practice’s front desk, which he called key to capturing good demographic information, co-pays, and balances. After all, he said, the patient is right in the office.

With regard to charge capture, he urged practices to make sure all charge tickets are accounted for, reconciled, and numbered. The most significant opportunity for lost charges occurs in chemotherapy, according to Farber. He encouraged refining the system for tying charges to inventory and making sure staff uses the automated system correctly.

Quick collections are vital. “Speed equals money. By getting money sooner, you don’t lose money to follow-up. The longer we take the more things can go wrong, from patient death to change of insurer,” he said. He noted that by just getting bills out faster, practices can see a “staggering, powerful result.”

Want more tips and advice on maximizing revenue? This presentation will be available online at

REMS: Workload vs. Risk Mitigation

Posted in Cancer Care, In and Around Washington, DC by ACCCBuzz on September 29, 2010

by Don Jewler, ACCC’s Director of Communications

I listened to spirited discussions at ACCC’s OPEN meeting as attendees examined risk evaluation and mitigation strategies (REMS) and the opposing forces inherent in REMS: feasibility (meaning increased workload) vs. risk mitigation.

According to the American Society of Health-System Pharmacists, about one-third of new molecular entities and biologic products approved by the FDA in the first half of 2010 have had a REMS required. Fifty-one new or revised REMS were approved by the FDA through June 2010.

“As we move forward there will be even more,” said OPEN meeting presenter Timothy Tyler, PharmD, FCSHP, who agreed that REMS can ensure safe use of prescribed drugs, including appropriate patient selection, monitoring and education.

“However, as the number and complexity of REMS program increase, the challenges associated with prescribing and dispensing the drug increases as well,” he noted.

The consensus of the recently empaneled NCCN working group was that REMS may add significant workload to prescribers and dispensers of drugs with REMS, making it potentially less likely for a drug with complex REMS to be used at all.

“I would take out the word ‘may,’ ” Tyler said. “Where is this going to stop? Something has to give between risk mitigation and feasibility. We need to focus on patients and patient care.”

Tyler and meeting attendees expressed concerns about the increased workload that REMS may require. Mr. Tyler urged a national strategy, perhaps streamlining to a single universal format, an online clearing house, and instant adjudication.

“REMS is an opportunity to improve patient care and support all stakeholders. REMS can ensure safe use of prescribed drugs, including appropriate patient selection, monitoring, and education. At the same time, this is a huge problem that this is coming back to pharmacy.”

White Bagging of Oncology Drugs: Growing Trend, Heightened Concerns

Posted in Uncategorized by ACCCBuzz on September 29, 2010

by Don Jewler, ACCC’s Director of Communications

What a crowd! About a hundred oncology pharmacists, administrators, and others pack the room Wednesday morning at ACCC’s Oncology Pharmacy Education Network (OPEN) in St. Louis. They’re examining white bagging, the practice of having patient-specific medications or supplies delivered directly to the practice setting (hospital outpatient infusion center or physician office) by specialty pharmacies for use by a specific patient.

“These products may be pre-paid or complimentary,” said presenter Bonnie Kirschenbaum, MS, FASHP, FSCHP. “No billing for these products or supplies transpires. They come directly to the practice site and for a specific patient, and are not handled like a regular pharmaceutical.”

That means, under white bagging, practice sites lose the opportunity to bill for the product while retaining the responsibility for storing and handling. Practice sites are responsible for the costs of ancillary meds and drug administration and only some of these are reimbursable.

“Zero dollars can be billed for the actual product or supply. Facilities don’t like this very much,” she noted with emphasis.

Add to that financial challenge, medications must be logged in, stored separately, labeled for each patient. “You may get a two-month supply or a day-by-day dosage. It depends on the insurance company,” said Kirschenbaum.

Ms. Kirschenbaum tried to stay neutral about white bagging. Still, she noted that hospital buy and bill is in the best interest of the hospital and provides continuity of patient care. She advised push-back during the prior authorization process when requested to use a specialty pharmacy. And if the insurance company uses ASP-based reimbursement, request ASP + 25 percent to 30 percent to include pharmacy overhead.

Her bottom line: Hospital and physician practice buy and bill is in the best interest of the hospital and oncology practices and provides continuity of patient care.

A New Face at ACCC

Posted in Cancer Care by ACCCBuzz on September 23, 2010

My team at Fox Chase. I'm second from right.

by Kim LeMaitre, Director of Educational Services, ACCC

As the new Director of Educational Services, I’m looking forward to speaking directly to ACCC members to better understand their education needs. My goal in this exciting position is to help ACCC achieve its strategic objective: to be an indispensable resource for knowledge exchange and education for its members.

Let me introduce myself. In my previous position, I was senior project manager at Fox Chase Cancer Center in Philadelphia, Pa., where I managed multiple grant funded projects, including the Pennsylvania Cancer Education Network. This is a state-wide initiative focused on providing community-based cancer education on prostate, colorectal, and ovarian cancers. In this role, I managed programs taking place in more than half of the counties in Pennsylvania. I was also training manager for the Atlantic Region’s Cancer Information Service, a program of the National Cancer institute, at Fox Chase Cancer Center.

Now that I’m at ACCC, I’ll combine my clinical knowledge in oncology with my experience in staff training to help you and your team.

If you’re coming to the National Oncology Economics Conference in St. Louis next week, please introduce yourself. Tell me how ACCC’s educational offerings can better serve you and your program.

This will be my first ACCC meeting. I plan to write commentaries and do my share of Tweeting.

The conference agenda is exciting. “Developing and Funding Integrative Therapies” and “Developing a Stellar Oncology Homecare Program,” for example, will explore the sustainability and resources needed to support such programs. I have lots of questions about oncology homecare: what concerns do patients and their families have about care outside the hospital setting? How does the transition work? Who oversees the care?

Another session will explore non-traditional partners (“Non-Traditional Partners: What Do They Offer and What Do They Want?”). I’m a big fan of “non-traditional.” Too often we’re set in our ways, not questioning who else can help us make a project or program work better.

Lots of sessions will explore current ACCC educational projects—from dispensing pharmacies at physician practices to patient transition to treatment in the community setting of patients with small-population cancers. Noted physician Stuart L. Goldberg will discuss a model for treating patients with chronic myeloid leukemia. I’ll be there!

Prostate Cancer Care: Advancing on Washington

Posted in Across the Nation, Cancer Care, In and Around Washington, DC by ACCCBuzz on September 17, 2010

by Richard B. Reiling, MD, ACCC member and former ACCC President, Presbyterian Cancer Center, Charlotte, N.C.

September is Prostate Cancer Awareness Month. This week members of the prostate cancer community have come to Washington, D.C., to participate in a national initiative called the Advance on Washington. They are calling for renewed commitments to finding answers that will enable physicians to cure more and over-treat less.

The nation’s leading prostate cancer organizations,including the Prostate Cancer Foundation, have issued a five point plan, targeted to policymakers, to accelerate research and discovery of effective prostate cancer treatments. The five-point call to action is timely and needed. Prostate cancer is a disease that will probably affect every living male in his senior years, and yet we know so little. Some of the current clinical trials are inadequate to answer the questions and often put the patient in the category of radical surgery when it may not be helpful, reminding me of the concern that women had 30 to 40 years ago with breast cancer. Grassroots efforts led to more awareness and subsequent research.

Today men with prostate cancer face a dilemma in initial treatment: radical surgery and/or radiation to active surveillance. And then, should they be assiduously screened with a test that is far less than perfect and not approaching the reliability of breast cancer screening? It’s clear that many men with the unpleasant side-effects of prostate cancer treatment could have been spared the troubles in the first place. In support of the urologists and radiation oncologists, however, it is still not clear as to who will die and who will just linger along without difficulty.

To me, it seems a logical use of federal and other sources of money to apply to prostate cancer research. Often as I watch the numerous ads on TV for sexual enhancement drugs, I’m reminded of the immense profits that could be directed to protecting men from needing prostatectomies in the first place.

I hope that this week’s Advance on Washington is effective.

This week the National Football League (NFL) and the American Urological Association Foundation teamed up to educate men about prostate cancer and encourage them to join the “Know Your Stats” campaign.

Note: ACCC’s 27th National Oncology Economics Conference features a session Friday, October 1, about ACCC’s Prostate Cancer “Best Practices” Project, Part II. An expert panel will explore what makes a successful community‐based prostate‐specific cancer program and how to develop a collaborative team approach to care.

Be sure to visit ACCC’s Center for Provider Education’s Prostate Cancer “Best Practices” Project, an excellent resource (including an archived webinar) for community cancer programs to help develop prostate-specific cancer services in their home communities.

Hospital-Physician Integration: A Growing Trend

Posted in Across the Nation, Cancer Care by ACCCBuzz on September 15, 2010

by Don Jewler, Director of Communications, ACCC

Two articles caught my eye in the July/August Healthcare Finance News.* Both examined the growing trend of hospital-physician integration within hospitals nationwide and the increasing number of physicians employed by hospitals.

What’s driving the trend?

According to Chelsey Ledue, author of both articles: “Influences on physician employment can include competition between hospitals and physicians, the desire of physicians for security, soured relationships between physicians and hospitals, and regulations constraining the options for formal business relationships other than employment.”

The desire for security rises from the uncertainty of reimbursement. This is particularly true in oncology practices. By some accounts Medicare is covering only 57 percent of physicians’ cost of administering chemotherapy. And private payers are following Medicare’s lead.

The increasing number of physicians employed by hospitals echoes findings from ACCC’s recent survey, Cancer Care Trends in Community Cancer Centers. More oncologists are relocating to hospital-based practices arrangements. Cancer program respondents were asked about consolidation of community oncology practices within their primary market area. According to their responses, physician oncology practices are consolidating even faster than cancer programs. In the past year, 29 percent of respondents report consolidation of physician oncology practices in their primary market area. In the next one to two years, almost half of respondents expect consolidation of physician oncology practices in their area, up from 30 percent in Year 1 of the survey.

As hospitals hire more physicians and try to align clinical strategies and compensation, keeping costs down will be an important goal, says Ledue. Budget-conscious hospitals may find physician alignment a challenge .

In a special session at ACCC’s 27th National Oncology Economics Conference in St. Louis, a panel of experts will examine the challenges as well as the pros and cons of many different hospital-physician alignment models, including professional services agreements. What are the implications for cancer programs and practices? Why are physicians turning to hospitals? ACCC designed this session to provide straight-forward answers, examine the options, and address concerns.

* “Considering Key Factors for Physician Alignment,” Chelsey Ledue, page 15, and “Majority of Established Docs in Hospital-based Practices,” Chelsey Ledue, page 17.

Read “Professional Services Agreements” by Chad Schaeffer, FACHE, in the July/August 2010 Oncology Issues.

Also, check out the August 25, 2010 Oncology Times, pages 23-24, “Preserving Private Practice by Collaborating with Hospitals,” by Mark Fuerst. Within the article, Barbara McAneny, MD, CEO of the New Mexico Cancer Center, notes that half of all hospitals now employ oncologists, with another 17 percent saying that there are plans to do that.


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