Journeying Beyond the Physical: Addressing a Patient’s Spiritual Concerns

By Susan van der Sommen, MHA, CMPE, FACHE

HC provider cupping patients hand (for web)Based on evidence presented in the Institute of Medicine’s 2008 report, “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs,” the American College of Surgeons Commission on Cancer (CoC) has phased in a new standard – 3.2: Psychosocial Distress Screening. The goal of utilizing a psychosocial distress screening tool is to ensure patients’ emotional and psychological needs are being addressed – in addition to their physical disease and symptoms.  CoC Standard 3.2 includes the following description of the psychosocial assessment:  “This assessment will confirm the presence of physical, psychological, social, spiritual [emphasis added], and financial support needs and identify the appropriate referrals as needed.”

In an article published in the March/April 2017 edition of ACCC’s journal Oncology Issues, the Reverend Lori McKinley outlines how Mercy Health lived up to its promise to “make lives better – mind, body and spirit” by incorporating a rating for various spiritual concerns of a patient or loved one. The Spiritual Care Team at Mercy recognized that just addressing emotional and physical needs of patients is not enough.  After performing an extensive literature review and developing connections with community-based organizations, the Mercy team made significant quality-related, evidence-based changes to their electronic health record (EHR) to accommodate a new and improved distress screening tool. Learn more about their pilot project here.

Indeed, a patient’s spirituality is directly related to their quality of life and has a direct correlation to giving  patients meaning, a sense of purpose and understanding during a critical time in their lives. In “Spirituality in the Cancer Trajectory,”  author C.M. Puchalski writes that “Spirituality is an essential element of person-centered care and a critical factor in the way patients with cancer cope with their illness from diagnosis through treatment, survival, recurrence and dying.” Her article goes on to identify the link between spirituality and “inner peace, gratitude and positivity” when facing a life-changing diagnosis such as cancer. She writes that with proper support, a patient may begin to view their cancer diagnosis as a positive life-changing experience, ultimately paying greater time and attention to higher priorities in their lives. This is not possible if a patient’s spiritual needs are not addressed routinely throughout their care.

Puchalski further points out that religion is but one type of expression of spirituality so non-faith based organizations should not dismiss the concept or its importance. In fact, she writes, a majority of patients want their oncologist or healthcare professional to address their spiritual concerns and integrate their needs and wishes into their care plan.

Not surprisingly, this is what the Spiritual Care Team at Mercy discovered during their pilot program. With the addition of four questions addressing spiritual concerns in their distress screening tool, they were able to more effectively connect patients with their faith, alleviate fears, and assist patients with addressing their trepidation at the end-of-life. Isn’t that what all of us want for our patients?

Reference

Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol. 2012;23(suppl_3):49-55.


Contributing blogger Susan van der Sommen, MHA, CMPE, FACHE, is Executive Director, DSRIP, Bassett Healthcare Network, and Chair of the ACCC Editorial Committee.

 

Why I’m Going to Capitol Hill On March 29

By Virginia Vaitones, MSW, OSW-C

U.S. CapitolACCC Capitol Hill Day 2017 happens to coincide with national Social Work Month, which the National Association of Social Workers is marking with theme Social Workers Stand Up.  As an oncology social worker, this year I’m putting on my patient advocate’s hat, standing up, and going to Capitol Hill to share with legislators the stories of how my patients are being impacting by worry and uncertainty about how  changes to the Affordable Care Act and the Medicaid program may affect their insurance coverage and access  to care.

My home state of Maine has the distinction of having the oldest population in the country per capita and Knox County, where I live and work, has the oldest population in the state.  Many of my patients who are on Medicare also have MaineCare (Maine’s Medicaid program) as their secondary insurance.  The current proposed changes to how the federal government supports states with Medicaid funding will have a tremendous impact on my patients.

Besides the elderly population that I need to advocate for, the proposed cuts and changes in payment will have an impact on my younger patients who become disabled with their cancer diagnosis and depend on Medicaid to cover the cost of their cancer treatments.  As a patient advocate, I will be standing up for these patients as well.

My advocacy skills also are needed to bring the stories of how cancer impacts parents, small business owners, and working adults with a cancer diagnosis, who for the first time were able to afford health insurance under the ACA and now face uncertainty about whether they will have coverage or be able to continue to afford the cost of coverage.

Last but not least, I work in a rural community hospital whose doors are always open and that will treat patients whether or not they have insurance coverage.  I need to advocate for my hospital so that we can keep our doors open.

Capitol Hill Day, March 29, will bring together ACCC members representing cancer programs from across the country.  Together we will be standing up for our patients, for access to quality care close to home, and for our cancer programs.


Virginia Vaitones, MSW, OSW-C, is oncology social worker at Pen Bay Medical Center in Rockport, Maine, and a past president of the Association of Community Cancer Centers (ACCC). 

Oncology Social Workers’ Role in Patient-Centered Care

By Fran Becker, LCSW, OSW-C

JPG-2017SWM-LogoWebMarch is National Social Work Month.  This year, the National Association of Social Workers’ theme is “Social Workers Stand Up.”  This is a time to acknowledge the contributions of all social workers.  Some social workers are part of a team, others work independently—all are patient centered in their approach to care.  Oncology social workers are part of this proud group—but our work differs in several ways.  While master’s degree prepared social workers are trained in assessing the psychosocial needs of their clients and in provision of a range of services, oncology social workers often have additional expertise and specialized clinical training in the meaning and impact of a cancer diagnosis on patients and their families.

Oncology social workers must have a working knowledge of cancer treatments, the side effects of treatment, and the psychosocial impact on the patient and family.  This skill set is a broad one, especially for those working in community cancer centers who are called on to help patients and families at all stages of illness and diagnoses. Oncology social workers may assist patients with a wide range of concerns, including issues faced by patients at high risk of cancer, those newly diagnosed, patients in active treatment, as well as helping with survivorship, palliative care, and end-of-life issues.

Oncology social workers need to be knowledgeable about individual and family coping styles, resources, clinical interventions, and employ a myriad of other skills to help patients and families manage the multidimensional (emotional, financial, and physical) impact of a cancer diagnosis through their long journey. This management can range from distress and depression screening to assisting with transportation issues. It can encompass educating patients (and their caregivers) about stress management and self-care. It can entail working with parents on how to talk about cancer in an age-appropriate way with their children or with employees on how to discuss their needs with their employers, and extend to finding community resources to assist with a number of problems.  And, at times, it is sitting with a family facing the loss of a beloved family member.

Key to success as an oncology social worker is the ability to be present, to engage open-heartedly with empathy and compassion, to start where the patient is, focus on hearing the patient and/or family needs, and helping them to meet those needs, which may range from a simple referral to managing complex multidimensional issues.

I often hear—“Your job must be very hard, I don’t know how you do it.” In my career as an oncology social worker, one of the most important things that I’ve learned after 30 years of working with cancer patients and their families is that it is a privilege to walk alongside them during their journey, whatever the outcome.  There are fears and tears, but laughter and warmth, too. To me, oncology patients and their families are role models of courage and grace in the face of an often traumatic and life-changing experience.

As we join in marking National Social Work Month, I would like to acknowledge my fellow oncology social workers and say “thank you” for your contributions as part of the multidisciplinary cancer care team.


Guest blogger Fran Becker, LCSW, OSW-C, is manager of Cancer Support Services, Carl & Dorothy Bennett Cancer Center, Stamford Hospital, and a past member of the ACCC Board of Trustees.

ACCC thanks all oncology social workers for their efforts as part of the multidisciplinary team delivering patient-centered care in cancer programs across the country.

Navigation Metrics & Value-Based Care: Measuring Up

By Tricia Strusowski, RN, MSN

Compass pointing at answers-SMALLAs the move to value-based care and Alternative Payment Models (APMs) continues, oncology patient navigators need to become more business savvy and have a full understanding about value-based cancer care metrics.  Case in point: Medicare’s Oncology Care Model (OCM) pilot, the first oncology-specific alternative payment model developed by the Center for Medicare and Medicaid Innovation (CMMI). Data collection and reporting metrics are integral elements of this five-year pilot program, which seeks to achieve higher quality, more highly coordinated care, and smarter spending.

The challenge: Navigation programs lacked strong evidence-based metrics to demonstrate the impact of navigation on the key areas of quality, coordination, and cost-effectiveness.

The good news: the Academy of Oncology Nurse & Patient Navigators (AONN+) recently released 35 evidenced-based metrics in the key categories of patient experience, clinical outcomes, and return on investment.

These metrics were developed using the AONN+  evidence-based Navigation General Certification Domains:

  • Community Outreach and Prevention
  • Coordination of Care/Care Transitions
  • Patient Advocacy/Patient Empowerment
  • Psychosocial Support Services/Assessment
  • Survivorship/End of Life
  • Professional Roles and Responsibilities
  • Operations Management/Organizational Development/Healthcare Economics
  • Research and Quality Performance Improvement

The metrics were developed so that any cancer program or practice can utilize them regardless of the navigation model in place.  The goal in providing these standard metrics is for cancer programs and practices to use them “as a baseline to prove the efficacy and sustainability of their [navigation] programs.”1 Learn more and access metrics.

Partnering to Advance Value-Based Cancer Care
As oncology providers work to improve care coordination and demonstrate delivery of patient-centered, efficient, quality care, patient navigators can play an important role in establishing connections by partnering with physician practices.

For example, navigators can integrate with physician practices to:

  • Increase efficiency and timely access to services by providing comprehensive assessments and referrals to appropriate disciplines
  • Reinforce patient education and empowerment through decision aids and patient appointment checklists
  • Create standing order sets, physician profiles, pathways, and guidelines
  • Increase support for clinicians, i.e., provide early discussions about palliative care, goals of care, advance care planning, and pre-habilitation
  • Increase contacts with “frequent flyers” to decrease ER visits and avoidable admissions
  • Provide automatic referrals to financial counseling at time of diagnosis (generate self-referral reports)

On Thursday, March 30, I will present a more in-depth look at the potential for “Creating Partnerships Between Oncology Nurse Navigators & Oncology Practices” in a session at the ACCC 43rd Annual Meeting, CANCERSCAPE.  The oncology landscape continues to evolve at a rapid pace.  I believe now is the time to explore how navigators can support value-based care initiatives with physician practices, as we all work to keep patients at the center of care delivery.

I hope to see you at CANCERSCAPE, March 29-31, 2017, in Washington, D.C.

Reference

1 Strusowski T, Sein E, Johnston D. Academy of Oncology Nurse & Patient Navigators Announces Standardized Navigation Metrics. J Oncol Nav Survivorship. 2017; 8(2):62-68.

_______________________________________________________________

ACCC member Tricia Strusowski, RN, MSN, is a consultant with Oncology Solutions, LLC, with 20 years of experience in patient navigation.

Does Your Cancer Program Have a Registered Dietitian?

March is National Nutrition Month, the ideal time for ACCCBuzz to spotlight the role a Registered Dietitian Nutritionist (RDN) plays in the delivery of high-quality, patient-centered cancer care.

By Kelay E. Trentham, MS, RDN, CSO

Heartshaped Fruits and Vegetables-smDo you have a Registered Dietitian Nutritionist (RDN) in your cancer center? If not—or if your RDN staffing is limited—you may be interested in what an RDN can do for your patients.

First, Some Background

What does it take to earn the RDN credential? To be a Registered Dietitian Nutritionist, you must first obtain, at a minimum, a bachelor’s degree in Nutrition from an accredited program. Next, you must complete a minimum of 1,200 hours of RDN-supervised practice in various settings including clinical, community, and food service rotations, among others. In the near future, a master’s degree will be the minimum required education, and currently many master’s programs are combined with internships. Finally, you must pass a registration examination before using the RDN credential. In some states, RDNs must also be licensed – which is denoted by the LD (licensed dietitian) or LDN (licensed dietitian nutritionist) credential.

Once you’ve earned the RDN credential , you must complete 75 units of continuing education every five years to maintain it. There are five RDN specialty certifications, one of which is for oncology. The CSO credential indicates that an RDN is also a Board Certified Specialist in Oncology. The CSO credential is earned by passing the CSO specialty examination, which is administered by the Commission on Dietetic Registration. To be eligible to sit for this exam, RDNs must have been practicing for at least two years and must be able to document 2,000 practice hours in oncology within the past five years. The CSO credentialing exam must be retaken every five years.

What Does an RDN Do?

Assessment. At a minimum, the RDN employs the nutrition care process and provides medical nutrition therapy (MNT) to patients deemed at malnutrition risk. The nutrition care process involves nutrition assessment, diagnosis, and intervention, as well as monitoring and evaluation. Nutrition assessment is the evaluation of a patient’s diagnosis and co-morbidities, anthropometrics, laboratory values, nutritional intake, psychosocial, socioeconomic, and cultural factors as well as a physical assessment. During a nutrition-focused physical assessment, the RDN notes changes in muscle and fat tissue, skin, hair, nails, and other physical indicators of macro- or micro-nutrient deficiencies.

Diagnosis. The assessment process leads to nutrition diagnosis: the determination of specific nutrition-related problems to be addressed such as malnutrition, altered gastrointestinal function, or impaired nutrient utilization. RDNs use standardized language for nutrition diagnoses, and indicate the etiology and related symptoms of the stated problem.

Intervention. With the assessment and diagnosis complete, the RDN next determines nutrition interventions to address the identified problems – such as diet modifications, oral nutrition supplementation, or enteral or parenteral nutrition support. Finally, the RDN will regularly monitor patients and evaluate the effectiveness of the interventions. The nutrition care process is ongoing until nutritional problems resolve or stabilize.

Nutrition Matters

Studies show that adult cancer patients with poor nutritional status experience decreased tolerance to cancer treatment, higher hospital admission or readmission rates, increased length of hospital stay, decreased quality of life, and increased mortality. A number of studies recommend that nutrition intervention for cancer patients be provided by an RDN, and others indicate that nutrition education on use of foods to maintain nutritional intake yields better quality of life over simply recommending oral nutrition beverages. Ideally all cancer programs would employ a validated nutrition screening tool, such as the MST or PG-SGA, to identify patients at malnutrition risk and refer those patients to the RDN for medical nutrition therapy. Indeed, the 2013 Oncology Evidence Analysis project of the Academy of Nutrition and Dietetics recommends these very practices: malnutrition risk screening (and rescreening), with referral of those who screen at risk to an RDN for MNT.

Engaging the Patient

In addition to identifying and treating or preventing malnutrition, a primary role for the RDN is the provision of patient education on topics ranging from dietary strategies for side-effect management to the pros and cons of vitamin, mineral or botanical supplement use during treatment to the efficacy (or lack thereof) of popular ”cancer diets.”  RDNs assist the healthcare team in identifying patients who would benefit from enteral or parenteral nutrition support during treatment, and can educate patients regarding the logistics of this therapy. RDNs can provide care coordination and navigation services when nutrition support is an integral part of treatment, for example, for patients with head and neck and esophageal cancers. The RDN may also address nutrition-related long-term and late effects of cancer treatments.  RDNs can play an important outreach role in educating patients and the community about evidence-based diet and lifestyle approaches for cancer prevention and survivorship.

The Bottom Line?

Malnutrition impacts patient outcomes, cost of care, and importantly, your patients’ quality of life. Nutrition care is a crucial component of the provision of not just adequate, but of high-quality, patient-centered cancer care. The RDN is your nutrition expert and should be an integral part of the multidisciplinary care of patients undergoing treatment in your cancer program.


ACCC member Kelay E. Trentham, MS, RDN, CSO, is 2016-2017 Chair, Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics. She is Oncology Dietitian at the MultiCare Regional Cancer Center in Tacoma, Washington.

 

Speak Up Now!

by Leah Ralph, Director of Health Policy, ACCC

U.S. CapitolFor this year’s ACCC Capitol Hill Day, Wednesday, March 29, ACCC advocates will descend on Washington, D.C., with newfound motivation. As Congress grapples with the future of the Affordable Care Act (ACA) and debates the merits of protecting patients with pre-existing conditions vs. high-risk pools, refundable tax credits vs. subsidies, requirements for essential health benefits vs. more flexibility in benefit standards, oncology care providers see insurance coverage—and their patients’ access to cancer care—at stake.

Yes, It’s Complicated
The political messaging—not to mention policy minutiae—is difficult to sort through, even for the wonkiest of policy wonks in Washington. The ACA has been plagued with insurer drop outs and significant premium increases for the unsubsidized individual market, but the law has also provided critical patient protections, put an end to discriminatory practices by insurers, and covered 20 million new lives through Medicaid expansion and the health insurance exchanges. Having made ACA repeal their rallying cry for years, Republicans are now trying to find a path forward to make changes to the law. But maintaining those critical (and politically popular) patient protections, preserving essential benefits, and covering more people while also reducing costs for both the system and the patients is far from an easy task.

Preserve Patient Protections
More than ever before, this year on Capitol Hill Day, ACCC members have a critical story to tell about the unique needs of cancer patients and the costs of their treatment. Cancer, in many ways, demonstrates the precise need—and role—for insurance. Cancer diagnoses are inherently unpredictable. Cancer patients can’t plan when they are going to be sick or what kind of insurance they will need to cover their costs. In addition to the personal, emotional, and physical toll a cancer diagnosis takes on individuals and their families, cancer patients need good insurance to protect against the risk of catastrophic treatment costs.

The ACA created critical protections for consumers, including eliminating the ability of insurance companies to discriminate based on a pre-existing condition, like cancer, or to impose lifetime or annual dollar limits on policies. And by providing subsidies to those up to 400 percent of the federal poverty level to purchase insurance, the ACA made progress in closing the disparities gap in accessing cancer care.

Protect Patient Access to Care
In record numbers, ACCC members will set out on March 29 to educate Congress on what proposed changes to the ACA would mean for cancer patients and survivors and their ability to access high quality cancer care in the communities where they live and work. In the context of any ACA repeal and/or replace plan, ACCC members will ask legislators to:

  • Protect access to comprehensive, affordable insurance coverage. This is particularly critical for cancer patients facing high-cost treatments that often turn into chronic, long-term conditions.
  • Preserve critical patient protections, such as the ban on discriminating based on pre-existing conditions, no annual or lifetime limits, guaranteed issue, and allowing dependents to remain on their parents’ plan until age 26.
  • Preserve essential health benefits that require insurers to cover preventive services, like cancer screenings, at minimal or no cost-sharing.
  • Maintain meaningful access to clinical trials.
  • Strengthen patient access to adequate provider networks that include cancer specialists and the full range of services required to provide quality cancer care.
  • Meaningfully engage cancer patient and provider groups in any real effort to repeal and/or replace the ACA.

Beyond coverage and access, ACCC members will also reiterate their commitment to value-based care and any efforts to improve quality, affordability, and access in cancer care. ACCC has long been committed to working with the Centers for Medicare & Medicaid Services (CMS) to achieve true high-value, cost-effective cancer care. ACCC members support the mission and goals of the ACA-created Center for Medicare and Medicaid Innovation (CMMI), which has been the subject of recent scrutiny. More than half of the CMMI Oncology Care Model (OCM) participating practices are ACCC members. These forward-thinking practices are dedicating significant time and resources to making this pilot program work.

However, in the wake of last year’s CMMI ill-conceived proposed Part B Drug Payment Model, ACCC members will also strongly encourage Congress to place additional guardrails on CMMI’s authority, including limiting its scope to targeted, voluntary (rather than mandatory) demonstration programs.

ACCC members have a lot to communicate to busy Congressional representatives and staffers this year. But the stories we will share, from the communities in which ACCC members are working on the frontlines of cancer care, will bring home the impact of policy decisions in the clearest, most powerful terms. Now is a critical time to speak up and be heard—for our patients today and those who will become our patients tomorrow. Join us for ACCC Capitol Hill Day. Your story can make a difference.


The ACCC 43rd Annual Meeting, CANCERSCAPE, March 29-31, will provide a 360-degree look at the healthcare landscape from the Democrat and Republican perspectives with insights on what to expect for reimbursement, alternative payment models, drug pricing, quality reporting, and more. Learn more.

What’s in a Name? Is “Tumor Registry” an Outdated Term?

By Holly J. Kulhawick, CTR

Jigsaw puzzle question mark-smThe National Cancer Registrars Association (NCRA) recently asked members on its Facebook page, “Is tumor registry an outdated term?” The responses were spirited and detailed the ways tumor registry and the Certified Tumor Registrar (CTR) credential can be confusing. For example, NCRA members noted that some of their colleagues and patients think they help patients register for treatment or that a CTR “certifies” tumors. There was a strong sense that the current terminology belittles what cancer registrars do, or gives the impression the work is less technically sophisticated than it is. In a time when registrars are struggling to defend the profession from automation and the fear that this automation will compromise data quality, the Facebook discussion suggested the time has come for the profession to revisit its terminology.

First, the term tumor is outdated on a number of fronts. Cancer registrars track more than tumors. They collect information on blood cancers and some benign and premalignant conditions. Second, the term tumor registrar is confusing. What does a “tumor registrar” do? A more descriptive term, such as Oncology Data Analyst or Oncology Data Manager, explains in three words the actual work of a registrar. Many NCRA members suggested this would help to emphasize the analytical aspects of the job and allow them to highlight to hospital administrators the role they play in supporting the cancer program and other oncology support services. Some facilities are already taking the lead, re-naming their Cancer Registry Department as the Oncology Support Services Department and updating their staff titles to Data Analysts. For some real-world examples of how CTRs can support an organization’s cancer program read “Unlock the Potential of the Cancer Registrar” (Oncology Issues, January/February 2016).

The Facebook posts also noted that the lack of clarity associated with “tumor registrar” does not help a profession that struggles to be recognized. A clear, concise title would go a long way to help elevate the work in the eyes of other health professionals. A change in terminology may also help with the Physician Quality Reporting System (PQRS), which is a quality reporting program that encourages individual eligible professionals and group practices to report information to Medicare on the quality of care. A title such as Oncology Data Analyst or Oncology Data Manager flags the cancer registrar as someone who can assist with PQRS requirements, helping to advance the role of the registrar.

A name change would also help with the general public. Some registrars noted that they have spent time explaining to patients that they are not the hospital staff to help them register for chemotherapy. A more direct or clear term would help to eliminate this confusion. The concept of registration—while reflecting accurately the work of a CTR—makes some patients nervous. When they learn they are part of a large cancer registry, they want no part of it, believing it is too much government oversight. If the terminology were changed to Oncology Data Analyst or Oncology Data Manager, it might better convey that skilled and certified professionals are collecting the data and its use is highly regulated and needed to advance cancer care and treatment.

The Facebook discussion suggested there is strong agreement on possible new terminology: Oncology Data Analyst or Oncology Data Manager. But what are the next steps? The National Cancer Registrars Association (NCRA) established a task force in 2008 to study the issue. At that time, there was insufficient member support to make a change. If members want to bring the issue to the forefront again, they can use NCRA’s formal process for members to be heard through its Advocacy and Technical Practice Directors (ATPDs). These board members serve as the liaisons between members and NCRA on matters of advocacy and technical practice. Interested members can go to the Raise Your Voice webpage to contact their ATPD to get the process started.


Guest blogger Holly J. Kulhawick, CTR, is Remote Abstractor for HCA/Methodist Healthcare San Antonio and Flatiron. 

Learn more about the pivotal role your cancer registry can play in supporting your cancer program, during a session on how to “Improve Your Data Collection—Streamline Your Accreditation & Quality Reporting Processes” at the upcoming ACCC 43rd Annual Meeting, CANCERSCAPE, March 29-31, in Washington, D.C.  Read the full agenda here

 

OCM Evolving Best Practices: Lessons to Date

By Monique J. Marino, Senior Manager, Publications & Content, ACCC

ThinkstockPhotos-507273299Last June, the Centers for Medicare & Medicaid Services (CMS) announced that nearly 200 physician group practices and 17 health insurance companies had been selected to participate in the Oncology Care Model (OCM), the first oncology-specific alternative payment model (APM) pilot. (According to the latest information on the OCM website, participant numbers now stand at 190 practices and 16 payers.)  At about 7 months into this brave new world, participants are beginning to share some lesson learned. At last week’s Cancer Center Business Summit in Las Vegas, a panel discussion on The Oncology Care Model: Evolving Best Practices, shed light on some of the challenges participants have experienced to date with the Center for Medicare and Medicaid Innovation (CMMI) model.

Panelist Diana Verrilli, Senior Vice President, Payer and Practice Management Solutions, McKesson Specialty Health, described the OCM as a “thoughtful and comprehensive model that is changing how people are being treated at our practices every day.” With 14 US Oncology practices—about 800 physicians—participating in the OCM, Verrilli shared three tangible outcomes that participants hope to see come out of the program: 1) a change in physician behavior, 2) improved use of clinical pathways, and 3) better patient outcomes, such as helping patients avoid hospitalizations.

OCM-related challenges that US Oncology practices have faced to date include:

  1. Developing processes to easily identify patients on oral oncolytics.
  2. Finding the resources and time required for practice transformation, for example, OCM participants are finding completion of the IOM care plan to be both time and staff intensive.
  3. Developing the complex care partnerships and pooling arrangements necessary to succeed under the OCM, e.g., adequate physician compensation.
  4. Creating processes and tools to needed to meet data submission and reporting requirements.

“If I could change one thing about the OCM,” Verrilli ended. “It would be to reduce the number of quality measures and the amount of documentation that is required.”

Fifty-five Flatiron practices across 20 states are also participating in the OCM. According to panelist Brenton Fargnoli, MD, Associate Medical Director Strategic Initiatives, Flatiron Health, challenges facing these practices relate to:

  1. Care management. How do you identify eligible patients? Keep track of data? Inform patients about their care plans—engaging and educating patients in their care.
  2. Program evaluation and reporting. How do you measure quality? Improve practice performance? Report to the OCM registry in the most cost-effective and efficient way possible?
  3. Revenue cycle management. How do you optimize practice income in the OCM model?

To meet these challenges, Flatiron is working with its practices to develop turnkey solutions, such as:

  1. Care management. Development of an e-process to do patient identification at point of care; Auto-generation of the IOM Care Plans in the EHR.
  2. Program evaluation and reporting. Structured data capture in the EHR; Auto-generation of an OCM Quality Measures Dashboard and OCM Registry reporting requirements.
  3. Revenue cycle management. Implementation of MEOS billing and collections tracking; Cost of care analytics.

When asked how the OCM could be improved, Dr. Fargnoli expressed sentiments similar to Verilli’s, “What’s working? Practices are very engaged and want to see the OCM model succeed. What’s not working as well—OCM rules and requirements are so complex that the majority of provider time is being spent on these documentation and reporting requirements.”

Finally, panelist Barbara McAneny, MD, Chief Executive Officer, New Mexico Oncology Hematology Consultants, shared concerns about the performance targets under the OCM, “If I could change one thing about the OCM, it would be the methodology by which the agency calculates targets so that practices can actually hit them. So how can CMS refine its targets? Give providers a year to collect the clinical data so that we can figure out why some patients are more expensive to treat than others. Using these data, we can work together to better refine OCM targets.”

For OCM participants interested in expanding the conversation, on Friday, March 31, 2017, ACCC is hosting the ACCC Oncology Care Model (OCM) Collaborative Workshop at the Renaissance Washington, DC, Downtown Hotel. Exclusively for OCM participants, the one-day event offers valuable, peer-to-peer learning with like-minded OCM professionals. The workshop will include snapshot presentations from OCM practices with innovative ideas and solutions for meeting OCM requirements, workgroups on hot topics, and a facilitated Q&A session. See registration details below.


The March 31, ACCC OCM Collaborative Workshop is an exclusive event for providers participating in the OCM. All attendees must pre-register for the OCM Collaborative Workshop through the CANCERSCAPE registration portal. To register, select the one-day OCM Workshop during registration checkout. Only those who are pre-registered for this workshop will be admitted. REGISTER TODAY.

Learn more about the ACCC OCM Collaborative here. This invitation-only platform provides a targeted discussion board and access to OCM-focused events. If your program is participating in the OCM and you have not received an invitation to join the ACCC OCM Collaborative, please fill out the form on the Collaborative Homepage to gain access to this peer-to-peer learning resource.

On the Road to Value-Based Care: Operational & Cultural Change

By Monique J. Marino, Senior Manager, Publications & Content, ACCC

2017-Open-Road-smWhile there can be no single roadmap for transitioning to value-based care, a panel session at the 2017 Cancer Business Summit, February 6-7, 2017, co-hosted by the Association of Community Cancer Centers, focused on  Operational & Cultural Change  that can help cancer programs move forward on the path ahead.  Sarah Chavarria, Chief People Officer, NantHealth, shared that successful organizational alignment is centered around these key concepts:

  • Strategy: mission, vision, and values; organizational goals; brand.
  • Structure: placing the right talent in the right role; holding people accountable for meeting organizational goals.
  • Talent: managing against a set of value-based competencies; assessing, developing, and growing the “best and brightest.”
  • Rewards: creating incentives that drive collaboration to deliver on organizational goals; these incentives should be flexible in design to attract and retain top talent—in other words, identifying what your employees value so that the organization can package them and reward behavior they want.
  • Systems and processes: these should enable decision making and responsiveness, and support effective execution.

“Cancer programs should create a ‘Deliberate Culture,’” Chavarria concluded. “If you are not deliberate in defining your culture, it will just happen; and it will not be what you want.”

Panelist James Grayson, a High Reliability Organization Specialist at West Cancer Center, outlined five key steps to help cancer programs succeed operationally and culturally:

Step. 1 Set your bar higher than everyone else’s.

Step 2. Hire people with potential.

Step 3. Invest in your front-line management team.

Step 4. Invest heavily in safety, risk management, leadership, and talent development.

Step 5. Be the cancer program your patients and staff need you to be.

Rounding out the panel was 2017 Cancer Business Summit Innovator Award Winner, Barry Russo, MBA, Chief Executive Officer, The Center for Cancer and Blood Disorders, who told attendees about the steps his cancer program took to move to value-based care, including:

  • Centralizing patient intake from 9 practice locations to 1 location, streamlining and improving care coordination.
  • Establishing triage as its own business unit.
  • Implementing an internal case management program to facilitate proactive intervention and risk stratification of patients.
  • Growing supportive care services (an effort that requires continual identification of new funding avenues), such as palliative care, chaplaincy services, nurse navigation, survivorship, etc.
  • Implementing a new patient education program.
  • Identifying technology gaps and improving decision-support around data and analytics.
  • Developing communication tools around value-based care to share with employer and payer communities.

To help cancer programs prepare for the change to value-based care, Russo offered five high-level takeaways:

  1. Deliver a consistent message; identify the changes needed and understand how to make these changes.
  2. Establish a new norm—while still a physician-centric care delivery model, ALL members of the care team are essential to healing lives after cancer. Value-based care requires cultural change and significant organizational re-engineering.
  3. Understand that staff and clinician education is a journey and not a destination. Accept that leadership must focus on education, re-education, and then more education. Effective team building requires repetition—leadership rounds, nursing forums, regular reports from pillars in the cancer program, etc.
  4. Be aware that nursing needs a hyper-focus. Nurses enjoy the most touch points with patients, so nursing stability is of the utmost importance to successful cancer programs.
  5. Build strong teams at EVERY level of the organization; teams that can process constant change. The move to value-based care is not for the faint of heart. Staff must be able to accept feedback; brutal honesty is essential to the process. Staff must accept that the move to value-based care means change is interrupting their day, not making it easier.

Learn more about what lies ahead for value-based care at the ACCC 43rd Annual Meeting CANCERSCAPE, March 29-31, 2017, in Washington, D.C. Join your peers to hear from leading experts and decision-makers about the evolving healthcare policy landscape, the latest on alternative payment models, data collection and quality measures, and more. Explore the meeting agenda here.

 

What Happened in Vegas: Highlights from the 2017 Cancer Center Business Summit

By Monique J. Marino, Senior Manager, Publications & Content, ACCC

Person in information spaceLast week in Las Vegas, the Association of Community Cancer Centers (ACCC) co-hosted the 2017 Cancer Center Business Summit, a two-day conference focused on how the business of oncology is being transformed by the dual drivers of science and technology. Featured speakers and panelists from cancer programs, technology innovators, patient advocate groups, and payers came together to explore how new technology impacts the delivery and future of cancer care. Session topics highlighted clinical pathways, advanced alternative payment models (APMs), patient-centered care, genomic science, and more. Below are highlights from three conference sessions.

A session on Clinical Pathways: With What Result? looked at how the use of pathways and guidelines have changed clinical practice in oncology and created value. Panelist Marcus Neubauer, MD, Medical Director, Oncology Services, McKesson Specialty Health and The US Oncology Network, offered four forward-looking takeaways:

  1. Quality, performance, and resource consumption will be measured for ALL Medicare providers via MIPS (the Merit-based Incentive Payment System) or APMs.
  2. The value of drugs and technology will be scrutinized carefully by ALL providers—public and private.
  3. Adherence to clinical pathways is a cornerstone for value-based care models.
  4. Practices must transform to meet value-based requirements; provide enhanced services; and be able to negotiate reimbursement contracts with payers that support these aligned efforts.

The focus on new reimbursement models continued in a session on Alternative Payment in Oncology: Today & Tomorrow.  Panelists offered perspectives on their experiences with APMs to date and their outlook for the future. Kelly Blair, MPA, Vice President Consulting, Sg2, shared results from a member survey, which found that:

  • 64% of Sg2 members are NOT participating in oncology-specific value-based or alternative payment programs.
  • Operational issues were cited as the biggest barrier to participation.
  • Of those that are participating, 80% are participating in the Oncology Care Model (OCM).

Panelist Dave Terry, Chief Executive Officer, Archway Health, offered lessons learned implementing bundled payment models:

  • Develop accountable incentives in your bundled payment contracts.
  • Leverage data analytics.
  • Ensure specialist engagement.
  • Embrace innovation.

And panelist Cynthia Terrano, Vice President Payer Strategies, Moffitt Cancer Center, noted the importance of getting payers involved in the conversation. “The train has left the station on APMs,” she told meeting attendees. “Cancer programs need to reach out to their payers now to develop partnerships and experiment with different alternative payment models.”

With data collection a pivotal piece of value-based payment, what help might lie ahead for community oncology? In a discussion on Big Data Platforms to Support Community Oncology, panelist Robert S. Miller, MD, Vice President and Medical Director, CancerLinQ, shared his perspective of what the future may hold, including:

  1. Widespread data sharing.
  2. Meaningful penetration of actionable oncology-specific technology.
  3. Real insights gleaned from unsupervised machine learning applied to next generation sequencing (NGS) output.
  4. Big data platforms supporting external compliance reporting.
  5. Real-world evidence used in regulatory decisions.
  6. Greater structured data capture in EHRs embedded in clinician workflows—a culture change aided by technology solutions.

At the end of a busy two days of sessions, one message came across loud and clear—it will truly take a village to deliver cancer care in the 21st century. Beyond the multidisciplinary cancer care team, this village will include technology innovators that are designing the IT infrastructure necessary to move from fee-based to value-based care; third-party laboratories that process and interpret the genetic and genomic tests required to deliver personalized or precision medicine; and specialty pharmacies that are critical to patients accessing life-saving medications and the financial assistance services they need to afford them.


March 29–31, 2017, in Washington, D.C., the ACCC 43rd Annual Meeting CANCERSCAPE will bring together policy experts and key stakeholders from leading national organizations to share insights on the status of the Affordable Care Act and how value-based care, drug pricing reform, and changes to Medicare will affect cancer programs and practices. Learn more. Early Bird registration rates end Friday, February 17.