The Cancer Registry’s Role in Creating Survivorship Care Plans

by Barbara J. Dearmon, BS, CTR

Solutions on corkboard (small)Survivorship Care Plans  are required by facilities accredited by the American College of Surgeons Commission on Cancer (CoC) and the National Accreditation Program for Breast Centers (NAPBC). These plans assist patients in being active participants in their post-treatment plan of care. The Survivorship Care Plan (SCP) helps promote continuity of care, provides a plan for future care, alerts the patient to delayed effects long after treatment has concluded, and provides a source document to share with future providers. Having a SCP helps patients maintain appropriate follow-up, such that late effects can be properly managed and recurrences identified and treated quickly. The SCP also provides the opportunity to address psychosocial and other health issues related to the cancer experience. The CoC’s Survivorship Care Plan requirements are outlined in Standard 3.3; the NAPBC’s requirements are detailed in Standard 2.20.

St. Vincent’s Medical Center Riverside in Jacksonville, Florida, is accredited by both the CoC and NAPBC. To meet these organizations’ SCP standards, St. Vincent established a Survivorship Committee in 2014 to examine the requirements and develop a process for disseminating SCPs and comprehensive treatment summaries to cancer patients who completed cancer treatment at the facility. The process also included a system to monitor and evaluate these efforts annually. The Survivorship Committee was multidisciplinary and included representatives from administration, cancer registry, information services, medical oncology, radiation oncology, surgery, clinical staff (physicians and nursing), and the survivorship nurse navigator.

The Survivorship Committee unanimously agreed that the cancer registry was the most complete data source for creating SCPs and treatment summaries to meet compliance with both standard-setting organizations. The cancer registry currently captures the majority of required data elements that will ultimately be included in these care plans. Some cancer registry software applications have the ability to interface data into a preformatted care plan template or Word document. St. Vincent’s reviewed several resources and decided to use Journey Forward, which interfaced easily with its cancer registry database. Policies and procedures were established to guide the process. Specific policies outlined the roles of the cancer registry staff and the survivorship nurse navigator and detailed the purpose, case eligibility, and dissemination process for the Survivorship Care Plans.

Role of the Cancer Registry:

  • The cancer registry generates a list of eligible cases abstracted using the cancer registry software and exports the data into Journey Forward.
  • The information for the care plans derived from the cancer registry database includes: cancer diagnosis, demographics, first course of treatment, stage of disease, and treating physicians. Treatment information to be captured includes chemotherapy, drugs administered (start and end dates), hormones, immunotherapy, radiation, and surgery.
  • Follow-up information on date-of-last contact is captured on the template. Cases are selected retrospectively, eight months from date-of-first contact at facility.
  • The cancer registry interfaces (exports) registry data into Journey Forward’s breast, colon, and lung templates.
  • For the primary sites that to do not correspond with Journey Forward templates, the cancer registry saves the information in a secured Excel file on a shared drive. The survivorship nurse navigator, with assistance from the cancer registry, manually enters demographics, treatment, stage, physician contact, and prognostic indicators into the Journey Forward’s generic template. The completed templates generated monthly from the registry database are saved in a folder located on the secured shared drive for the survivorship nurse navigator to access.

Role of the Survivorship Nurse Navigator:

  • The survivorship nurse navigator accesses the shared drive and selects the current cases for the month. The survivorship nurse navigation obtains from patient records and/or the physician office the clinical documentation necessary to complete the survivorship care plan and treatment summary.
  • The survivorship nurse navigator reviews information for accuracy and contacts the cancer registry if there are questions related to data interfaced from the registry database.
  • The survivorship nurse navigator works with outside physician offices to obtain necessary information to complete the remaining care plans.
  • The survivorship nurse navigator contacts the patient and offers an appointment to review the SCP in-person.
  • If the patient declines an appointment, a hard copy of the SCP with a cover letter and contact information is mailed to both the patient and the patient’s primary care provider.
  • All correspondence with the patient is documented in Nursenav Oncology, St. Vincent’s nurse navigator software. In addition to generating templates in Journey Forward, clinical staff use Nursenav to chart information and all correspondence with patients.
  • The survivorship nurse navigator maintains an electronic copy of all completed SCPs.

The Survivorship Care Plan process at St. Vincent’s is evaluated and monitored on a regular basis by the survivorship nurse navigator and the facility’s Cancer Committee. Tracking to ensure compliance with the process is presented to the Cancer Committee and the breast program leadership annually at a minimum.

Implementation of a Survivorship Care Plans benefits patients, who will be better informed about the treatment they’ve received and the resources available to ensure continuity of care. There are a variety of ways for a facility to develop Survivorship Care Plans and to ensure these plans are disseminated and the needed follow-up conducted. At St. Vincent’s, the multidisciplinary team that formed its Survivorship Committee, believed the cancer registry and the survivorship nurse navigator played critical roles. As facilities develop their process for implementing SCP plans, they too may want to consider the role of the cancer registry. Resources to help a facility get started include the American Cancer Society; American Society of Clinical Oncology; Institute of Medicine; Journey Forward; LIVESTRONG; and the National Cancer Institute.

Guest blogger Barbara J. Dearmon, BS, CTR, is manager, Oncology Support Services, at ACCC Cancer Program Member St. Vincent’s Medical Center, Jacksonville, Florida.

Creating a Navigator Orientation Checklist

By Tricia Strusowski, MS, RN

Compass pointing at answers-SMALLI remember when I first started our oncology navigation program in 1998; there were no national standards or core competencies for navigation. The only model I was aware of that followed the patient through different levels of care was the case management model. The goals of the case management model were to coordinate the patient’s care at the appropriate setting while keeping costs down. We discussed the plan of care with the physician and also spoke with the patient and their family to discuss their specific needs and whether their care could be handled at home or whether they needed an alternative care setting or level of care.  

Fast forward to 2016. Today navigation has support from the Institute of Medicine,  the Commission on Cancer has added a navigation standard to its Cancer Program Standards, the Oncology Nursing Society (ONS) has developed oncology nurse navigator  core competencies, and there is a joint position statement on the role of oncology nursing and oncology social work in patient navigation from ONS,  the Association of Oncology Social Work (AOSW), and the National Association of Social Workers (NASW). (Note: The George Washington University Cancer Center has developed core competencies for non-clinical patient navigators.) Today, our navigation programs follow the patient across the care continuum from the earliest point of entry though survivorship or end-of-life services.

Despite the fact that we now have navigation standards and core competencies in place, I still hear from navigators, “I was hired and told, ‘Go navigate.’ I had no idea what that meant.”

So, how do we teach our new navigators? Typically nurses come to the navigator role from varied backgrounds—the inpatient oncology unit, chemotherapy infusion suite, radiation oncology, and home care, just to name a few.

As with any new job, a robust orientation is key; a full navigation curriculum including an orientation checklist and annual competencies is essential for a solid foundation. Here is one example of the elements a navigator orientation checklist might include:

Navigator Orientation Checklist

  • Hospital-specific policies/procedures and mandatory educational programs
  • Navigation history, definition, and models of navigation
  • Benefits and goals of navigation
  • Job description, roles and responsibilities of navigator, and support staff
  • Commission on Cancer Standards and Cancer Committee responsibilities
  • Institute of Medicine; Delivering High-Quality Cancer Care
  • NCCN, ASCO, and other national guidelines
  • Referrals to the navigation program
  • Internal resources, roles and responsibilities:
    Social workers
    Registered dietitian
    Financial assistant/advocate
    Health psychologist
    Pastoral Care
    Genetic counseling
    Cancer  registry
    Rehabilitation team
    Palliative Care team
    Hospice team
    Other, __________________________________________________
  • Community resources, list_____________________________________________
  • Patient educational materials, i.e., disease–site-specific information, clinical trials, patient journal, etc.
  • Caregiver toolkit and resources
  • Assessment tools, documentation and reporting
  • Communication and managing transitions with the patient, family and/or caregiver
  • Communication among the healthcare team, internal and external resources
  • Patient experience survey process
  • Performance improvement models and initiatives:
    Patient experience
    Clinical outcomes
    Business performance
  • Support groups and educational programs
  • Tumor conference responsibilities
  • Multidisciplinary participation and responsibilities
  • Professional organizations and certification
    AONN, Academy of Oncology Nurse Navigators
    Association of Oncology Social Work
  • Other, list _________________________­­­­­­­­­­­­­­­­­­­­­­­­_____________________________________

This orientation checklist is just a foundation for your new oncology navigator; adjust to your specific needs and navigation model. Remember: a good orientation is key for your new navigator’s success.

Guest blogger ACCC member Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.

A Message to New Oncology Nurses

By Sandy Balentine, MSN, RN,OCN, MBA

Nurse and Patient Holding Hands(small)Although it’s been many years since I was a “new oncology nurse,” I still remember those first few days as a new graduate nurse.

Nurses touch people’s lives in many ways. They usually spend more time with the oncology patient than the patient’s physician or any other professional caregiver, and can develop a very intimate bond with their patients. Patients and families will remember their nurses for the care they provide during a very difficult time of the patient’s life. The public has a high level of respect and trust in the nursing profession. As a new oncology nurse, you are entering one of the most rewarding professions in the world in one of the most challenging specialties in healthcare.

Having completed your training, as a new nurse you are now responsible for everything you do. You try to do everything the right way, just as your clinical instructor taught you, only to find out that the oncology area in which you are working operates a little differently from the way that you learned to do things in nursing school. This sometimes causes your mind (and your stomach) to do a somersault.

A number of stressors make the job of nursing for cancer patients one of the most challenging— as well as rewarding—of all fields. With that in mind, here are some realities to consider so that you can be prepared and manage the stresses that come with this noble profession—especially when you are a new graduate.

Coping with the Challenges of Your New Role

How will you handle some of the stressors of your work environment—fulfilling the high-pressure job demands of nursing, floating to other nursing units, and struggling with the work load, while adjusting to a new role? Here are some tips to help you adjust to your new reality:

  • Build relationships with your colleagues.
  • Never be afraid to ask questions. It is okay to let people know that you do not have all the answers. Nursing is a lifelong learning profession.
  • Know your limitations. Don’t be afraid to express them, in a professional manner, if you feel uncomfortable when asked to do something.
  • Soak up information as much as you can—watch and listen—and you will learn so much more than you learned in school.
  • If your hospital doesn’t assign one, find a personal mentor to be your support person for the first year. You will need someone to talk to about your first days in nursing.
  • Take the time to do things right the first time, even if you think there is no time. Chances are, you won’t have to do it over.
  • Develop good organizational skills.
  • Do not complain about something unless you have a solution. Simply put: be a part of the solution rather than a part of the problem.
  • Always have integrity—you will gain the trust and respect of everyone you come in contact with.
  • Listen to your patients and their families; they know their bodies better than you do.

A Few Words of Advice . . .

So what advice do I have to share with upcoming new graduate nurses?  First, believe in yourself, it is the key to having self-confidence in what you do. Second, everyone has different learning patterns. Know your learning style and seek resources to complement how you learn best. And one last piece of advice: don’t let anyone make you feel discouraged.  As a new nurse, it can be easy to feel discouraged. You are working with other nurses who have more experience than you. You may sometimes feel uncomfortable when talking to a physician about a situation and don’t want to appear as “new.” A patient might even question your ability because they can sense that you are nervous. But always remember that you have been trained for this, and you have others to support you. You care about others and that is why you joined this profession.

Nurse to Nurse Support

We “seasoned” oncology nurses also have a responsibility to the new nurse. We must recognize the difficult transition that a new nurse has to make. Nurse orientation programs need to be personalized to nurses’ individual training and development needs. Such customized development to meet new nurses’ needs creates engaged employees. They will be working with cancer patients who have very specialized needs.  So in addition to teaching our new nurses about these special needs, we must also provide the support they need in their new role. Nurse residency programs are the best programs to help a new nurse through the challenges of their first year of practice. The best mentoring programs guide new nurses through career progression and show them how to be good nurses.

Leadership Training

You also may have heard the saying: “Nurses don’t leave organizations; they leave managers”; thus, leadership training is essential. Investing in leadership training benefits the entire organization. An organization’s leadership must foster a healthy work environment and set clear expectations. They must pay attention to staff’s professional development. The best leaders set realistic expectations, and inspire their nurses through their example.  They coach and nurture new graduates and create a patient care environment to support their staff.

Encourage new nurses to become involved with committees and councils that affect their practice. This can not only help them to feel more a part of their nursing environment, but also encourages them to have a voice in their organization.

Caring and Compassion

The Chief Nursing Officer at The Valley Hospital had a message for our nursing staff recently: Nursing has its roots in caring, and equally important for nurses is their ability to be compassionate with patients, and to use themselves as a therapeutic vehicle for healing.  Nurses’ compassion and their empathy is really just as important as their technical skills. And it is that relationship between the patient and the nurse that really brings healing to the patient. This message should also hopefully touch the hearts of new graduate nurses. Remember why you decided to join this profession. You will make such a difference in the lives of the patients you touch!

ACCCBuzz contributing blogger Sandy Balentine, MSN, RN, OCN, MBA, is the Director of Clinical Oncology at ACCC Member Program, The Valley Hospital. Her article for Oncology Issues (May/June 2016) describes the development of “The Oncology Nursing Fellowship Program” at her institution.

Bridging the Gap and Improving Outcomes

By Susan van der Sommen, MHA, CMPE, FACHE

ThinkstockPhotos-507273299Healthcare is becoming increasingly complex. With emerging payment models, regulatory initiatives, HCAHPS, and the complexity of electronic health records (many of which don’t communicate with each other), the concept of patient care has changed. How often have patients expressed dismay that their care provider seem more focused on the computer screen than on their needs and concerns? The endless entry of data, best practice alerts, and hard stops that are intended to streamline and improve care have unintentionally added complexity. In fairness to the evolving nature of electronic health records (EHRs), they have added benefits, too. They cannot, however, replace the value of human interaction.

In the November/December 2016 Oncology Issues, Connie Savage shares how Cancer & Hematology Centers of Western Michigan was able to address a complex issue that cannot be effectively resolved through a high-tech initiative—the transition of care from the inpatient to the outpatient setting. In today’s healthcare environment it is challenging to add positions that are not either revenue-generating and/or required by a regulatory agency or credentialing body. Yet the team at Cancer & Hematology Centers of Western Michigan was able to build a case to hire an inpatient coordinator who is charged with improving patient, provider, and family satisfaction and provider efficiency while reducing no-shows, hospital length of stay (LOS), and avoidable readmissions. At this program, the inpatient coordinator serves in a role similar to a patient concierge—gathering and sharing pertinent information, establishing patient and provider expectations, and arranging appointments—ensuring that the patient’s experience and transition to the home and/or outpatient setting is comprehensive and seamless. The return on investment is clear: improved patient and provider satisfaction, a streamlined discharge process, a reduction in length of stay (LOS), and a decline in avoidable admissions and readmissions. These outcomes align well with evolving payment models including, but not limited to, CMMI’s Oncology Care Model. It is likely that Connie and her team rely heavily on their EHR; however, they have proven that a technology-driven solution can never replace a caring human touch.

The story behind the story. ACCC member Connie Savage shared her role as inpatient coordinator at the 2015 ACCC National Oncology Conference New Member Meet & Greet in Portland, Oregon. Our ACCC editorial team heard her story and encouraged her to contribute an article to ACCC’s journal, Oncology Issues. Connie also agreed to share her program’s pioneering approach to patient care by presenting a poster at the recent ACCC 33rd National Oncology Conference in St. Louis. Connie’s story is great example of how our member programs are able to showcase their work on a national scale and share their “how-to’s” with other ACCC-member cancer programs. We are grateful to Connie and all our members who take the time to share their innovative approaches to success and ultimately improve care for our patients.

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

Radiation Therapists’ Role in Patient-Centered Care

By Bryan M. Schmalhofer, MBA

Hands-creating-circle-of-supportA new ACCC white paper, Empowering Patients, Engaging Providers: The Future of Patient-Centered Care in Oncology explores current challenges and barriers, and what’s needed to make headway in improving patient-centered oncology care. Derived from discussion at the ACCC 2016 Institute for the Future of Oncology forum, the report identifies seven elements required to provide true patient-centered care: patient stories, navigation and coordination, interdisciplinary teams, appropriate reimbursement for services rendered, greater education, information technology connectivity and transparency, and decision-support tools. For this blog post, I’d like to zero in on the first item: knowing the patient’s story. Or put another way, knowing the person, and not just the patient. Our current healthcare environment—with time constraints, data collection and reporting requirements—can make it challenging to know our patients’ stories. That said, we know that members of our multidisciplinary care teams do get to know our patients—one such team member is the radiation therapist.

Radiation Therapists & Patient-Centered Care

Patients undergoing radiation therapy will often interact with radiation therapists on a daily basis for weeks. While our patients and their family members cannot typically discern whether the radiation therapy treatment we are delivering is working, or if it will have a positive benefit in the future—what they do register is a warm greeting and the smiling face and listening ear of the radiation therapist delivering the treatment together with all of the members of the radiation oncology team. This daily contact between radiation therapists and their patients can have a profound impact on the patient experience and the quality of patient-centered care. Therapists have the unique perspective of being able to observe subtle changes in a patient’s demeanor and side effects, both new and ongoing sequelae. Often the skin changes seen by the nurse and physician during the weekly treatment visit can change markedly over the course of the week. Radiation therapists seeing these skin changes can have an important effect on the patient’s experience with radiation oncology by serving as another care touch point or intervention prior to the weekend. Examples include something as simple as changing the type of cream the patient uses to making sure the patient has the proper pain medication before the weekend.

By listening to their patients’ concerns, fears, and questions, radiation therapists not only get to know their patients, but also can help create an environment where the patients feel like they are at the center of their care. For example, given the complex nature of radiation therapies, one of the key drivers to patient satisfaction is the management and explanation of the side effects they will face during treatment and recovery. In fact, this point is specifically measured by the Press Ganey patient satisfaction survey that asks patients to rate the “Explanation of how to manage radiation therapy side effects.”

At WellSpan Health, the Oncology Service Line, has chosen to evaluate this measure and its effect on patient-centered care by adding another “touch point” with the therapists on a weekly basis. Our weekly on-treatment visits (OTVs) are done typically on a Monday. The therapists review the patient’s previous OTV note, and on Thursday the therapists ask specific, pointed questions concerning side effects that were raised and discussed during the OTV. The therapist then documents that these issues were discussed with the patient. I believe this adds to the level of communication, care coordination, and patient-centric care the patient experiences during their radiation therapy treatments and demonstrates a true patient-centered approach to their care and overall well-being.

The Institute of Medicine (IOM) has described patient-centered care delivery as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” On the frontlines of cancer care delivery, radiation therapists are often the “face” of radiation therapy, providing a welcoming presence and connecting with patients to help improve their care experience.

Guest blogger Bryan M. Schmalhofer, MBA, is manager, Radiation Oncology Operations at ACCC Cancer Program Member WellSpan Health, York Cancer Center. He also serves on the ACCC Editorial Committee.

How Cancer Registry Data Can Improve Public Health

by Linda Corrigan, MHE, RHIT, CTR

Crowd of multidisciplinary people-for webCancer registrars are data information specialists that capture a complete history, diagnosis, treatment, and health status for every cancer patient in the U.S. These data provide essential information to researchers, healthcare providers, and public health officials to better monitor and advance cancer treatments, conduct research, and improve cancer prevention and screening programs. Registrars collect the data on a daily basis to submit to state cancer registries. States supported by the National Program of Cancer Registries (NPCR) share their data with this national program. The Centers for Disease Control (CDC) Cancer Surveillance Branch is home to NPCR, which was established by the Cancer Registries Amendment Act, a law Congress enacted in 1992. As a result of this law, cancer is the only reportable chronic disease, allowing the CDC to disseminate accurate national incidence data. CDC uses data from NPCR to respond to various cancer inquiries from the public, government agencies, researchers, and Congress. By understanding the burden of cancer, public health organizations, including the CDC, can create programs and interventions for prevention and early detection.

CDC highlights the difference data are making at the state level through its Success Stories program. These stories highlight how the data collected through the NPCR are used in research to improve public health. Read examples from Massachusetts and New Hampshire  below. To learn more about NPCR data click here.

NPCR Program: Massachusetts Cancer Registry

Initiative: Disparities in Cervical Cancer Mortality among Black, Non-Hispanic Women in Massachusetts

Public Health Issue: In Massachusetts, despite high rates of screening, black, non-Hispanic women are more likely to be diagnosed late for cervical cancer, and have the highest cervical cancer mortality rates compared with women of other racial or ethnic groups.

How Cancer Registry Data Were Used: The Massachusetts Cancer Registry (MCR) provided incidence rates for cervical cancer by race. For the years 2005-2009, the incidence rate for black, non-Hispanic women was 2.5 per 100,000 versus a rate for white, non-Hispanic women of 1.4 per 100,000. The Massachusetts Department of Public Health established the goal of reducing the proportion of black, non-Hispanic women with late stage (regional and distant) cervical cancer to 2 per 100,000 by 2016.

Collaboration and Outcome: The MCR, the Behavioral Risk Factor Surveillance System, the Office of Clinical Prevention Services, and the Comprehensive Cancer Control Program collaborated to prepare presentations on incidence, mortality, and screening to illustrate cervical cancer disparities in Massachusetts. The Massachusetts Department of Public Health also contracted with JSI Research and Training Institute to conduct a series of focus groups with consumers, providers, and community leaders to explore and identify factors contributing to a late stage cervical cancer diagnosis.

Summaries of each focus group were written and analyzed from three unique perspectives: consumer, community leader, and provider. Three key findings included: 1) follow-up of medical care after an abnormal Pap test results is a significant challenge; 2) inadequate or no insurance coverage is a barrier to screening and follow-up; 3) constant changing of both treatment and screening guidelines cause confusion among patients and providers. The final recommendations included: 1) development and implementing a cervical cancer education and awareness campaign; 2) re-examining and assessing cervical cancer screening guidelines; 3) improving patient-provider relationships. As a result, a media campaign focused on breast and cervical cancer to emphasize the benefits and importance of early detection and of follow-up of abnormal results with a doctor. Media included newspapers, buses/billboards, and posters at YMCA, nail salons, gas pumps, and social media. In addition, a campaign for providers offered online Continuing Medical Education credits through the Massachusetts Medical Society.

NPCR Program: New Hampshire State Cancer Registry

Initiative: WISDOM: An Interactive Tool for Accessing Cancer Data in New Hampshire

Public Health Issue: More than 75 percent of all cancers are diagnosed in persons 55 years of age and older, and New Hampshire’s population has the fourth highest median age in the U.S. As the population ages, cancer is becoming a more visible public health problem. As a result, the New Hampshire Department of Health and Human Service is receiving increasing numbers of data requests and queries from researchers, hospitals, physicians, public health organizations, and concerned citizens. The New Hampshire State Cancer Registry and NH Department of Health and Human Services (DHHS) encourage cancer data use by these stakeholders.

How Cancer Registry Data Were Used: Many of the data requests received by NH DHHS require simple analyses. The New Hampshire State Cancer Registry decided to create a web-based mechanism through which stakeholders could easily obtain simple aggregate cancer registry data summaries.

Collaboration and Outcome: The NH Web-based Interactive System for Direction and Outcome Measures (WISDOM) website was developed at the NH Division of Public Health Services (DPHS). This web-based portal provides information related to health risks, outcomes, and DPHS performance metrics to staff, public health partners, and the public. The DPHS Management Team approved 14 dashboards across six public health topic content areas: Cancer, Cardiovascular, Injury Prevention, Diabetes, Asthma, and Tobacco. The Public Health Topics Module of WISDOM contains interactive and customizable “Dashboards” to provide easy access to health data in NH. The Data Reports Module of WISDOM can generate tables and figures from state cancer registry aggregated data for some cancers, including counts or rates stratified by age-group, sex, year, county and public health region, where those can be safely provided without jeopardizing patient confidentiality.

These are just two examples of how cancer registry data can be put to work to help to better meet the health needs of our communities. Read more examples of cancer registries in action here. How is your cancer program putting its cancer registry data to work?

ACCC member Linda Corrigan, MHE, RHIT, CTR, is President of the  National Cancer Registrars Association.

Why It’s Important to Carefully Examine Your Practice’s 2015 PQRS and QRUR Reports

by Brittney Fairman, Policy Analyst, ACCC

Centers_for_Medicare_and_Medicaid_Services_logoOn September 26, 2016, the Centers for Medicare and Medicaid Services (CMS) made available the 2015 Physician Quality Reporting System (PQRS) Feedback Reports and the 2015 Annual Quality and Resource Use Reports (QRURs) for every group practice and solo practitioner nationwide. The reports identify providers by their Medicare-enrolled Taxpayer Identification Number (TIN), and reflect who satisfactorily reported data on quality measures under PQRS and, in the QRURs, how physicians performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier. Importantly, these reports will determine whether a practice or solo practitioner will receive a bonus or negative payment adjustment in 2017.

In 2017, those who fail to meet the 2015 PQRS reporting requirements may be subject to a penalty of up to two percent, and practices may face a Value Modifier penalty of up to four percent when performance is compared to national quality and cost performance.

ACCC  encourages members to carefully examine these reports, particularly for inaccuracies, and contact CMS with any questions or concerns about perceived discrepancies. The window to request an informal review is September 26 – November 30, 2016. These reports are not automatically distributed, but must be accessed by authorized representatives from the CMS Enterprise Portal using an Enterprise Identity Data Management (EIDM) account established with CMS.

Reviewing these reports is particularly important in the context of new requirements under the Quality Payment Program (QPP) which will determine reimbursement based on similar measures starting in 2019.

If you are having trouble getting an adequate response from CMS after having contacted them about inadequacies in your PQRS or QRUR Report, please contact  Brittney Fairman at

For questions about the 2015 Annual QRUR, 2017 Value Modifier or how to request an Informal Review, contact the Physician Value Help Desk: Monday – Friday, 8:00 AM – 8:00 PM EST             Phone: 1-888-734-6433 (option 3);  Email:

For PQRS and EIDM questions, contact the QualityNet Help Desk:                                       Monday – Friday, 8:00 AM – 8:00 PM EST;  Phone: 1-866-288-8912 (TTY 1-877-715-6222);           Email:


CMS 2017 OPPS & MPFS Final Rules: Top-Level Takeaways

By Leah Ralph, Director of Health Policy, ACCC

Centers_for_Medicare_and_Medicaid_Services_logoThis week the Centers for Medicare & Medicaid Services (CMS) released the final CY 2017 Hospital Outpatient Prospective Payment System (OPPS) and Medicare Physician Fee Schedule (MPFS) rules. ACCC is currently analyzing the rules and will hold a webinar for members with more in-depth information in the coming weeks. Below are some key highlights.

Outpatient Prospective Payment Systems CY 2017 Final Rule

CMS estimates that the policies in the final rule will increase OPPS payments by 1.7% in 2017. The big news: in the final rule, the agency goes forward with the site-neutral payment provision for new off-campus provider based departments (PBDs):

  • Newly built or acquired off-campus PBDs: CMS finalized its proposal to no longer allow new off-campus PBDs (that were not billing under OPPS as of November 2, 2015) to bill under OPPS beginning January 1, 2017. CMS is finalizing the Medicare Physician Fee Schedule (MPFS) as the applicable payment system, but is also establishing new MPFS rates specifically so that hospitals can be paid directly for these new (what CMS is calling “non-excepted”) items and services. Hospitals will be paid under the MPFS at these new rates, which will be billed on the institutional claim and must be billed with a new claim line modifier “PN” to indicate that an item or service is non-excepted. For 2017, the payment rate for these new services will generally be 50% of the OPPS rate (with some exceptions, including payment for separately payable drugs, which will not be reduced). Packaging and certain other OPPS policies will continue to apply. Important: CMS specifically notes that items and services provided at new off-campus PBDs will continue to be reported on the hospital cost report and therefore eligible for 340B drug discounts if the parent hospital is a 340B eligible hospital. Find discussion of the impact of this policy on 340B discounts on pages 648-649 of the final rule.
  • Existing off-campus PBDs: CMS largely backed off its proposal to limit the expansion of outpatient items and services that can be billed under OPPS for existing off-campus provider-based facilities. PBDs that were billing under OPPS prior to November 2, 2015, can continue to bill for those services under OPPS—and expand those services beyond the 19 clinical families CMS had originally defined in the proposed rule. However, CMS has said that these facilities must remain at the same physical address to continue to bill under OPPS unless it is an extraordinary circumstance, such as a natural disaster. This may be short lived though as CMS also indicated it will continue to look at this and that the agency is “interested in what data…could be collected that would allow us to implement a limitation on service expansion” for these exempted facilities.
  • Packaging Policies:
    • CMS is finalizing its proposal to create 25 additional C-APCs, which are primarily major surgery APCs within the various existing C-APC clinical families.
    • The agency is finalizing its proposal to base packaging on a claim, rather than on date of service, so that services that are provided during a hospital stay that spans more than one day are packaged.
    • CMS finalized the expansion of a policy that excludes molecular pathology tests from CMS’ laboratory packaging policy to other Advanced Diagnostic Laboratory Tests (ADLTs).

Physician Fee Schedule CY 2017 Final Rule

The CY 2017 Medicare Physician Fee Schedule final rule focuses on policies aimed at improving pay for primary care, chronic care management, mental health care, and diabetes prevention. The rule’s provisions are expected to have a neutral impact on hematology/oncology, radiation oncology, and radiation therapy centers, and a -1% impact on radiology. Select cancer-related provisions include:

  • Payment for Mammography Services: CMS finalized a new coding framework based on new CPT coding for mammography services. The coding revision reflects use of current technology used in furnishing these services, including a transition from film to digital imaging equipment and elimination of separate coding for computer-aided detection services. CMS is maintaining current valuation for the technical component of mammography services in order to implement coding and payment changes over several years.
  • Medicare Telehealth Services: CMS finalized the addition of several codes to the list of services eligible to be furnished via telehealth, including: advance care planning services, end-stage renal disease related services for dialysis, and critical care consultations furnished via telehealth using new Medicare G-codes. CMS is also finalizing payment policies related to the use of a new place of service code specifically designed to report services furnished via telehealth.
  • Appropriate Use Criteria for Advanced Imaging Services: The Protecting Access to Medicare Act (PAMA) of 2014 established a new program to promote the use of appropriate use criteria (AUC) for advanced diagnostic imaging services under fee-for-service Medicare. As a component of the Medicare AUC program, CMS finalized the first eight priority clinical areas, which include cancer of the lung (primary or metastatic, suspected or diagnosed). CMS also finalized the clinical decision support mechanism (CDSM) application to allow for preliminary or full qualification; the deadline for the first round of applications is March 1, 2017.

View fact sheets for both rules here: OPPS and PFS.


Life, Interrupted: One AYA Patient’s Cancer Journey

From the recent ACCC 33rd National Oncology Conference, this is the second in a two-part blog series highlighting featured speaker sessions focused on adolescent and young adult (AYA) cancer patients.

NOC 2016 Crowd

On Friday morning, October 21, conference attendees heard the AYA patient voice loud and clear in a riveting presentation by Suleika Jaouad, author of the award-winning New York Times column, “Life, Interrupted.”

“My name is Suleika Jaouad, and I am a cancer survivor.” With that Jaouad began the story of her experiences as a young adult with cancer.

“Looking back, the symptoms had been there for awhile,” she said. But getting to a diagnosis turned out to be a lengthy, arduous, and scary process.  Originally told she had “burnout syndrome,” it took months to eventually learn that she had an aggressive form of leukemia. At 22 years of age, Jaouad had no family history of cancer, she always ate organic, and was a straight A student. Lesson learned: “Cancer doesn’t care what your GPA is or how good a person you may be, because cancer doesn’t discriminate.”

Life interrupted is what cancer feels like, Jaouad said. Overnight she lost everything she had worked for as a young adult, having to move back home into her childhood bedroom. “I lost my job, my apartment, and maybe worst of all, I lost my independence.”

Knowledge is Power, But. . .

Where and how to find the “knowledge” about your cancer and treatment “was a bigger challenge than I expected,” she said. With providers, she often felt “lost” in the conversation. “I wanted to understand what lay ahead, but often felt too overwhelmed, intimidated, and sometimes embarrassed to ask them to explain and re-explain.”

While searching the Internet, she came across a list of side effects and “one word stuck out to me—infertility.” No one on her medical team had mentioned this side effect to her. “Lack of information on that felt like a breach of trust early on in my treatment. . . . I wanted to make this decision with my medical team,” she said, not have it be a decision that was made for her. “Preserving my ability to be a mother one day felt like a very important lifeline to a very uncertain future.”

Once she brought the topic up with her team, she was provided with resources. But lesson learned: Clear, open communication between herself and her medical team was not always a given. She would have to take an active role in her treatment.

Echoing Thursday morning’s Helping AYAs Be Loud! session’s call to action, Jaouad emphasized that AYAs face unique medical, professional, and psychological challenges. It’s almost as if AYAs are oncology’s tweens, she said, too old for pediatrics but too young for the adult oncology unit. Young adults are a misunderstood and overlooked part of the cancer patient population.

I Wanted a Cure, Not a Trial

In 2011, at the end of the first round of treatment a biopsy showed that standard treatment hadn’t worked and she was going into bone marrow failure. Because a bone marrow transplant was becoming less likely, Jaouad said, she had to face the possibility that she might not be cured. It was then that she learned about clinical trials. Ultimately, she enrolled in a trial and after 8 months was in enough remission for a bone marrow transplant.

Survivorship: Unknown Terrain

Although she received excellent care, Jaouad did not learn about her cancer program’s survivorship care clinic until after she wrote a column focused on how, as a cancer survivor, she lacked any kind of roadmap for the way ahead. She was then connected to the cancer center’s survivorship program, which provides resources to help patients stay healthy in the long-term both physically and psychologically.

Lesson learned for providers: Make sure patients are connected to the resources that are already in place. After all, “what’s the point of going through all these treatments if it’s not to live a good life and a healthy and meaningful life?”

Stay tuned for more from the ACCC 33rd National Oncology Conference. Read about an innovative program for AYAs at Seattle Children’s Hospital’s Building Hope (Oncology Issues Nov/Dec 2013).







Helping AYA Patients to Be Loud

By Amanda Patton, ACCC Communications

What does it mean to “be loud”? Sometimes it means just being heard.

Lauren Lux speaks at the ACCC 33rd National Oncology Conference.

Lauren Lux speaks at the ACCC 33rd National Oncology Conference.

For adolescent and young adult (AYAs) cancer patients, that can be a challenge. Two powerful sessions at last week’s ACCC 33rd National Oncology Conference focused on how to “hear” the voice of AYAs and understand what patient-centered care looks like to this under-served patient population. This two-part blog series recaps key session takeaways.

In the opening session of the conference, Lauren Lux, LCSW, UNC Lineberger Comprehensive Cancer Center, along with Niklaus and Lucy Steiner, co-founders of the Be Loud! Sophie Foundation, reminded the hundreds of conference attendees just how important it is to raise the volume about the unique and unmet needs of AYA cancer patients. In establishing the Be Loud! Sophie Foundation, the Steiners are honoring the vision of their daughter, Sophie Steiner, who passed away in 2013. The foundation’s name comes from lines of a poem Sophie wrote:

The Steiners speak at the ACCC 33rd National Oncology Conference.

The Steiners speak at the ACCC 33rd National Oncology Conference.

. . . Be loud

And move with grace

Explode with light

Have no fear…

Sophie’s vision was to help young cancer patients stay true to themselves in the face of overwhelming illness. The foundation has helped create the Adolescent and Young Adult Program at UNC Lineberger Comprehensive Cancer Center.

Why Be Loud?

Each year nearly 70,000 AYAs (roughly between the ages of 15 and 38) are diagnosed with cancer, Lux said. This group is:

  • Severely under-represented in clinical trials
  • Less likely to access “adult” oncology support services
  • More likely to experience financial toxicity as a side effect of cancer
  • Seeing only a modest increase in cure rates over recent decades.

The bottom line: AYAs have unique and unmet needs, Lux said.

How can cancer care providers better “hear” AYAs—and help these patients’ needs be addressed? The first step is establishing effective communication. Lux, who is director of the Adolescent and Young Adult Program at the UNC Lineberger Comprehensive Cancer Center, shared practical communication tips for connecting with and empowering AYAs. “You don’t have to be cool,” she reassured attendees. What you do have to be is:

  • authentic
  • flexible
  • compassionate
  • honest
  • willing to get to know the PERSON not just the PATIENT

A second step is to recognize how important having some control over their lives is to AYAs. “I consider myself an ‘opt in’ activity for people,” said Lux. Rather than scheduled appointments, she will drop by patients’ rooms and ask if the timing is good for them. She also encourages lots of visits from friends. The Steiners, too, stressed how important it is for AYAs to have connection with the non-medical, outside world.

Have the Sex Talk

Conversations about fertility preservation and sexual activity are not one-time events for AYAs, Lux said. Fertility preservation is a huge issue for this patient population. It is expensive and is usually not covered by insurance. AYAs need information about sex before, during, and after treatment, and these conversations should also involve their partners, she emphasized. For cancer programs, it is essential to decide who on the care team “owns” having this conversation with patients and their significant others, she said. “When no one owns it, it doesn’t happen.”

With the AYA population, the caregiver role is complex and nuanced. Helping ensure that adolescent and young adult patients are empowered to voice their choices is important, Lux said, and it’s important to empower them in their conversations with their providers.

Take Action

Lux offered some no-cost steps that cancer programs can take today to improve care for their AYA patients:

  • Schedule AYA clinic days—arrange for adolescent and young adult patients to come to clinic on the same day
  • Create an AYA Advisory Council
  • Explore social media options, for example, blogs
  • Provide information on local and national AYA organizations
  • Check out online resources, such as Stupid Cancer and Stupid Cancer meet ups.

The session’s number one takeaway: Ask your AYA patients what’s important to them.

Learn more in part two: “Life, Interrupted, One AYA Patient’s Cancer Journey.”