Connecting the Moonshot to Patients

By Amanda Patton, ACCC Communications

ACCC President Jennie R. Crews, MD, MMM, FACP, welcomes conference attendees.

ACCC President Jennie R. Crews, MD, MMM, FACP, welcomes conference attendees.

The Cancer Moonshot framed Thursday’s  sessions at the ACCC 33rd National Oncology Conference in St. Louis. “I’ve been privileged to be part of the conversations around the Moonshot,” ACCC President Jennie R. Crews, MD, MMM, FACP, told attendees in her opening remarks. On Monday Dr. Crews participated in panel discussion at the White House as part of the Moonshot Task Force Report unveiling. With a goal of making a decade’s worth of progress in cancer prevention, diagnosis, treatment, and care in five years—it’s an “audacious” initiative that will bring challenges and significant opportunities to community oncology, she said.

In a heartfelt video message to conference attendees, Vice President Joe Biden, called community cancer centers the “bridge” between the Moonshot and cancer patients. “For the overwhelming majority of those patients who are diagnosed [with cancer], the next step leads to you,” he said. “Community oncologists treat as much as 85 percent of cancer patients . . . .Not only do your patients need you, your country needs you.”

It was a message reiterated at the end of the day by Anabella Aspiras, Director for Patient Engagement, Cancer Moonshot Task Force, in a session exploring how the Cancer Moonshot will affect providers in the community setting. “You truly connect the work of the Cancer Moonshot to cancer patients,” she told attendees. Ms. Aspiras highlighted the three Moonshot reports announced on Monday:

The Vice President’s Executive Report, a summary of work accomplished to date and challenges that must be addressed, which was presented to President Obama on Monday. The report outlines five strategic imperatives:

  • Realign incentives in the research system
  • Enhance prevention efforts
  • Engage patients as partners in research
  • Expand access to care
  • Convene a national conversation about cost.

The Task Force Report, covers the implementation plans for accelerating progress and includes Moonshot efforts underway over the past year.

The Blue Ribbon Panel Report, which integrates feedback into the panels 10 recommendations.

Anabella Aspiras and Jennie R. Crews, MD, MMM, FACP, at the ACCC National Oncology Conference.

Anabella Aspiras  with ACCC President Jennie R. Crews, MD, MMM, FACP, at the Cancer Moonshot Report unveiling earlier this week.

In her remarks, Ms. Aspiras called attention to existing ACCC initiatives that support the Blue Ribbon Panel recommendations, including the Institute for Clinical Immuno-Oncology (ICLIO) and ACCC’s educational work related to integrating biomarker testing in the community setting.

In her role at the Moonshot Task Force, Ms. Aspiras’ primary responsibility is to represent the voice of the patient in four areas: addressing cancer inequities, enhancing community cancer care, improving clinical trial participation (accrual and retention) in particular in terms of under-represented populations; and survivorship. Research must benefit all segments of society, Aspiras said. “We must ensure advances in treatment are distributed equally.”

In closing, Ms. Aspiras thanked ACCC members for the work they do. “You bridge the gap between our efforts on the Cancer Moonshot and the patients we aspire to reach,” she said. “Every day you change the face of cancer as we know it.”

Stay tuned for more from the ACCC 33rd National Oncology Conference. Follow the conferences highlights on Twitter #ACCCNOC.


OPEN Pre-Conference Highlights

By Amanda Patton, ACCC Communications

New ACCC "Hub" in the Exhibit Hall, one-stop for resources, informatiion, and membership information

ACCC “Hub” in the Exhibit Hall welcomes conference attendees with a central source for resources and information on everything ACCC.

We’re in St. Louis for the ACCC 33rd National Oncology Conference this week. Events got underway on Wednesday, October 19, with dynamic pre-conference sessions focused on some of the most challenging and rapidly evolving areas in cancer care delivery. Read on for highlights from the Oncology Pharmacy Education Network (OPEN) pre-conference.

A morning panel discussion during the OPEN Pre-Conference focused on strategic planning for the oncology pharmacy. Zaven Norigian, PharmD, BCOP, Beth Israel Deaconess Medical Center, moderated a discussion with Steve D’Amato, BSPharm, New England Cancer Specialists, and Ali McBride, PharmD, MS, BCPS, BCOP, University of Arizona Cancer Center, that touched on some of the toughest challenges for oncology pharmacy today. Among these:

Cost of drugs. Pharmacy budgets continue to increase, the value of inventories in clinics is escalating, and if programs are not paid in a timely manner, cash flow problems will result. With the increase in immunotherapies and new oral agents, programs are wrestling with how to afford of these therapies and provide access to these for all of their patients. “The bank is going to break eventually,” said D’Amato.

Implementing genomic testing. Operationalizing this in the community setting is creating big challenges for the oncology pharmacy, panelists agreed. It requires a multidisciplinary approach providing integration and education for clinical pharmacists and nurses. There must be buy-in from everyone.

EHR and data issues. Programs need to be able to mine their data, understand their data, and reduce the staff time needed to collect and report data. Pharmacy is looking to technology to solve some of these important issues—without being “nickel and dimed to death” by their EHR vendors, panelists said.

USP 800. This is top-of-mind if you work in pharmacy, panelists agreed. Among the pressing challenges: How do you explain issues related to USP 800 compliance to the C-suite? Attendees were urged to act now—if they haven’t already—and at a minimum bring in a consultant to determine what it will cost to be compliant by 2018. “We know it’s going to be costly…it’s not something you can flip the switch one day and start it,” said Norigian.

Succeeding with Oral Oncolytics

An OPEN Pre-conference session tackling a critical current day challenge highlighted ACCC’s education initiative, Steps to Success: Implementing Oral Oncolytics. (The session was broadcast live, and will be available on the ACCC website on-demand soon.)

“One of the biggest challenges with oral oncolytics is that we put so much responsibility on the patient,” said presenter Niesha Griffith, RPh, MS, FASHP, West Virginia University Health System. Pharmacists need to be “on the frontlines” of taking care of oncology patients, she said.

Calling attention to the Steps to Success white paper developed as part of this ACCC initiative, Griffith focused on the project’s key programmatic recommendations for successful integration of oral oncolytics:

  • Take a multidisciplinary approach
  • Assign responsibilities; clearly identify who is responsible for what
  • Work collaboratively with specialty pharmacy (as needed)
  • Provide financial advocacy services
  • Develop a robust patient education program
  • Put in place effective processes for monitoring for adherence and toxicity
  • Maximize the use of technology

Griffith stressed the importance of developing robust case management platforms so that all providers can document information from patient visits. Where possible, develop methods to streamline processes. For example, devising a streamlined process for prior authorizations can help avoid pulling staff away from frontline care for this time-consuming task. Access more resources from ACCC on successful integration of oral oncolytics here.

Stay tuned for more from the ACCC 33rd National Oncology Conference from ACCCBuzz. Follow the conference highlights on Twitter #ACCCNOC.

With Final MACRA Rule, CMS Increases Flexibility

By Leah Ralph, Director of Health Policy, ACCC

Healthcare costsOn Friday, October 14, the Centers for Medicare & Medicaid Services (CMS) released its final rule on the MACRA Quality Payment Program (QPP).  ACCC is conducting an in-depth analysis of the rule; however, an initial look reveals that CMS has heard the stakeholders’ message  loud and clear: Make the transition to MACRA as simple and flexible as possible. Here are some top-level highlights from the final rule:

  • Low-volume threshold exemption: the agency broadened the low-volume threshold exemption from the Merit-Based Incentive Payment System (MIPS), exempting practices with less than $30,000 in Medicare charges or fewer than 100 unique Medicare patients per year. This will exclude about one-third of physicians from having to report under the Quality Payment Program (QPP).
  • Pick your pace: CMS is allowing physicians to “pick their pace” in 2017, enabling physicians to avoid negative penalties in 2019 by reporting on some data (i.e., one quality measure) for some period of time. The takeaway: even minimal performance reporting will exempt physicians from any penalties, and opportunities for a shorter, 90-day reporting period will make providers eligible for positive adjustments. (Providers must start collecting data between January 1, 2017, and October  2, 2017, and report no later than March 31, 2018.)
  • Resource use category weighted zero in first year: MIPS has four components, and originally the resource use (cost) category was going to account for 10% of your score starting in 2017. CMS has now said this category will hold zero percent weight toward your MIPS score in the first year [in 2017, the percentages will be: 60% quality measures, 25% advancing care information (EHR use), and 15% clinical improvement activities].
  • Expanding opportunities to participate in APMs: CMS has also said it plans to expand opportunities to participate in models that qualify as “advanced alternative payment models” (APMs) in 2017 and 2018. The Center for Medicare and Medicaid Innovation (CMMI) also informed Oncology Care Model (OCM) practices on Friday, October 14, that CMS is amending the program to allow OCM practices to take two-sided risk as early as January 2017 to qualify as an advanced APM (two years earlier than the model originally allowed).

In our comments on the proposed rule, ACCC asked for increased flexibility for practices who are still building the infrastructure to meet these requirements, and a streamlining of reporting requirements as our members increasingly engage in new delivery models and navigate the path to value-based care. ACCC’s major concerns were around timeline and administrative burden – in the final rule, CMS was responsive in many ways, but ACCC will continue to work with the agency to reduce regulatory burden and make this a workable payment system for our members.

For more information, CMS launched a website for physicians that explains the program and allows you to explore and identify different measures that are most meaningful to your practice. Find a summary of the rule here. The AMA and ASCO also have great checklists on how to prepare for participation in the QPP.


The Oncology Pharmacist’s Role in Patient-Centered Care

By Annie Lambert, PharmD

ThinkstockPhotos--pharmacy2-for-webI knew I wanted to be a pharmacist after I completed a job shadow at our local hospital when I was a junior in high school.  I was fascinated by the role pharmacists played on the healthcare team, joining providers on rounds and troubleshooting issues related to medications and infusion pumps.  It was clear to me early on that it takes a whole team to achieve the best outcome for the patient.  My path led me to oncology pharmacy, where my passion for patient care was fed and my mind was challenged daily. I was able to engage with patients and the healthcare team on another level.  It was a pleasure to see my patients each week, giving them relief of their side effects when I could, and developing relationships over the course of their treatment.  Over the years, our cancer program grew to include more team members.  What a privilege to collaborate with my multidisciplinary colleagues–social workers, dietitians, nurses, physicians, nurse practitioners, and so many others on our care team.

As we all know, it takes a special type of person to work with cancer patients.   I am fortunate to work with an exceptionally dedicated and compassionate team of oncology pharmacists and technicians.  Many of them have a personal connection to cancer, while others enjoy the challenge of keeping up with new drugs and treatments.  But all of them say their favorite part of their job is talking with our patients.  Another testament that patients are at the heart of what we do!

 The Oncology Pharmacist’s Unique Role

Not all patients can say they have a personal relationship with their pharmacist.  Many patients come to us thinking about their pharmacy team at their local drug store, but oncology pharmacists do so much more!  At MultiCare Regional Cancer Center, each new patient meets with a pharmacist to review their treatment, side effects, and symptom management strategies.  If an oral chemotherapy is prescribed, our pharmacist helps connect them to the right specialty pharmacy or supports the prior authorization team to ensure the patient gets their treatment started.  During their treatment, a pharmacist will check in with them to help manage their nausea, bowels, or electrolytes. This is the care model that intrigued me as a high school student and still demonstrates value today.

New Technologies and Challenges

Over the years, new technologies have entered into our cancer program, changing the way my team interacts with patients—among these are advances that enable an electronic health record (EHR), computerized provider order entry (CPOE), smart infusion pumps, barcode scanning . . . I could go on! But it’s important to recognize that these high-tech tools do not replace the personal, high-touch work that we do; instead, they enhance our work, making the care we provide safer and more efficient. And at times, in the midst of a launch of new technology, it can be hard to keep that in mind. But the fact is, these new tools, too, are about delivering patient-centered care.

Oncology is an ever-evolving discipline.  The number of new drugs approved in the last few years is staggering!  For patients, this is an exciting time with the potential for more choices with fewer side effects. Or, for example, to know that their drug regimen is tailored to the genetic markers on their cancer.  For pharmacists and other oncology clinicians, this makes it more challenging than ever to keep up with the latest trends and treatment options. What do we need to build into our electronic medical record protocols and infusion pump libraries?  How do we learn enough about a new drug to ensure we are treating patients safely on the first dose and on the twelfth or twentieth dose?   What type of toxicity—physical or financial—should we be prepared for? How much does this cost our organization and our patients?

We have come so far yet we still have so much to learn!   We strive to improve our processes and quality to better serve our patients.  With each new drug, initiative, or technology upgrade, let us remember to keep our focus.  Patients are at the heart of the team.

National Pharmacy Week is coming up October 16-22.  Take a few moments to thank a pharmacist or technician you know, whether directly part of your cancer program or the team that indirectly supports your patients. 

On October 19,  ACCC is presenting the Oncology Pharmacy Education Network (OPEN) Pre-Conference in conjunction with the ACCC 33rd National Oncology Conference (October 19-21) in St. Louis, MO. 

Annie Lambert, PharmD, is Oncology Pharmacy Manager at ACCC member program MultiCare Regional Cancer Center in Tacoma, WA.

ICLIO Conference: Top-Level Takeaways

By Amanda Patton, ACCC Communications

ICLIO Conf-Dr. Schwartzberg-for web

ICLIO Advisory Committee Chair Lee S. Schwartzberg, MD, FACP

The Institute for Clinical Immuno-Oncology (ICLIO) National Conference on September 30 in Philadelphia provided a window into the real-world immuno-oncology (I-O) issues facing providers, patients, and payers.

Across conference sessions some overarching themes emerged. One prevailing message:  there is an on-going need for practical, real-world education on immunotherapy, immune-related side effects, and response patterns—not just for the multidisciplinary cancer care team and allied specialties, but also for Emergency Department (ED) staff, hospitalists, and all others who connect with patients, including front desk staff.

To reduce barriers to accessing I-O, a message reiterated throughout the day was:  make immunotherapy clinical trials more widely available in the community.  Citing the Cancer Moonshot Blue Ribbon Panel Recommendation #2, which calls for a clinical trials network for immunotherapy, ICLIO Advisory Committee Chair Lee S. Schwartzberg, MD, FACP, said, “It would be a shame to limit this to [just] a few institutions. The entire community needs to be engaged,” including populations that are currently not well-represented in clinical trials, such as the elderly and underserved patient populations.

Implementing I-O: Real-World Challenges

ICLIO Conf panel-for web

Providing Community and Academic Perspectives on I-O Implementation, Panelists (L to R) Jose Lutzky, MD, FACP; Tara Gangadhar, MD; Lee S. Schwartzberg, MD, FACP

In a panel discussion on Community and Academic Perspectives on Implementing immunotherapy, Dr. Schwartzberg noted that I-O has moved out into the community “very quickly.” His own clinic’s experience tells the story.  In 2014, his clinic treated two patients with immunotherapy. To date in 2016, that number has climbed to 306 patients treated with immunotherapy.

What issues are top of mind in clinic every day? Response rate and patterns, pseudo-progression, and immune-related adverse events, said Dr. Schwartzberg.

Panelist Tara Gandahar, MD, Abramson Cancer Center, University of Pennsylvania, emphasized that “patients on immunotherapy need 24/7 access to providers who can assess issues and make a plan,” and that night coverage is of critical importance.  Patients who experience toxicity require increased monitoring both by phone and with in-person visits, she said. At the same time, it’s important to reassure patients that discontinuing therapy for toxicity does not mean they won’t see a therapeutic response.

Delivery of immunotherapy requires the involvement of multiple specialties, in particular gastroenterology and endocrinology, added panelist Jose Lutzky, MD, FACP, Mount Sinai Medical Center Comprehensive Cancer Center. Education on immunotherapy is needed for primary care providers, ED staff, ICU staff, surgeons, as well as house staff, he said.  Bringing immunotherapy to patients requires a collaborative team effort—with physicians, nurses, social workers, pharmacists, financial advocates, and others.

Building an I-O Dream Team

During a panel focused on the ideal team for successful implementation of I-O in the community, Gary Cohen, MD, Greater Baltimore Medical Center, urged that in preparing the general community for handling these agents, providers not become “complacent” in giving I-O drugs. “They must be ready for the rare side effects,” he said.

Dr. Cohen outlined the I-O dream team as including oncologists (medical, radiation, surgical), family and caregivers, nurses (especially important in terms of side effects education and monitoring), pharmacy, financial counselors/advisors, business managers, plus other medical specialists as needed such as endocrinology, GI, pulmonology, neurology, and radiology.

For smaller hospitals contemplating integrating I-O in the community setting, panelist Carole Miller, MD, St. Agnes Hospital, suggested the following six essential I-O program building blocks:

  • Multidisciplinary care
  • Shared decision-making
  • Expertise, especially regarding side effects of immunotherapy treatment
  • Patient education and support
  • Clinical trials
  • Administration buy-in and understanding of the importance of I-O.

Her cancer program has created an Immuno-Oncology Center, a separate space just outside the infusion center with I-O resources and a dedicated nursing staff.

Sigrun Hallmeyer, MD

Sigrun Hallmeyer, MD

As immunotherapy for cancer has grown, so has the size of the I-O dream team, said Sigrun Hallmeyer, MD, Cancer Specialists, SC.  Still, the “backbone” of her I-O program remains her nursing staff.  A theme throughout the conference was the critical role nurses play in educating patients on I-O side effects, monitoring and following up with patients on symptoms and side effects. Dr. Hallmeyer’s practice uses an educational sheet that nurses go through with patients when they start on immunotherapy. The practice pharmacist will not release the I-O drug unless the patient sheet on side effects is signed off on by the nurse and entered into the electronic medical record (EMR). Early detection of toxicity is the team’s goal.

Looking at the Value-Based Environment Ahead

As the healthcare system transitions to value-based reimbursement models, providers, patients, and manufacturers all confront the question of how these new payment models will impact I-O and innovation. During a panel discussion on alternative payment models (APMs) and immunotherapy, numerous concerns were raised, including the following:

  • Pathways and/or bundles: If these are mandated, how will they affect clinical advances and innovation?
  • Will the value-based environment constrain innovation?
  • How will CMMI’s Oncology Care Model (OCM) impact oncology and I-O? How might use of immunotherapy agents impact performance under the OCM? If CMS deems the model successful, it’s likely to spread rapidly to private payers, noted panelist Michael Seiden, MD, PhD.
  • How will APMs incentivize innovation? To get buy-in, APMs must reward innovation, otherwise incentives will be driven in the wrong direction, cautioned panelist Jennifer Hinkel, MSc, McGivney Global Advisors.

Pharmacy Operations & Issues

Reimbursement challenges were a central issue during a pharmacy-focused panel discussion. Whether in the academic or community setting, “immunotherapy agents are creating a lot of work in terms of getting reimbursed. It’s resource and time intensive,” said panelist Niesha Griffith, MS, RPh, FASHP, University of West Virginia Health Center.  She shared three practical steps to improve I-O reimbursement:

  1. Get approval for everything and enroll all patients in patient assistance programs.
  2. Add dedicated reimbursement staff. Patient financial advocate/support positions pay for themselves ten times over, she said.
  3. Get a seat at the table. Meet with your payers on a quarterly basis and include your pharmacy reimbursement staff in the meeting.
ICLIO Conf Edward Li-for web

Ed Li, PharmD, MPH, BCOP

Clinical issues are merging with administrative issues which is impacting the care delivery infrastructure, commented Edward Li, PharmD, MPH, BCOP, University of New England.  Looking to the future, “as we start to replace standard of care chemotherapy and move to trying to cure our patients, as we incorporate genetics and molecular testing, how will these fit into pathways?”

Panelist Nicky Dozier, PharmD, Virginia Oncology Associates, cited the growth in the number of pathways as a burden for providers. “Oncology pathways need to do more than just restrict decision making,” she said. Greater transparency is needed in terms of who has participated in the creation of the pathway, for example, were oncologists involved?

Take a deeper dive into the ICLIO National Conference by viewing the speaker slide presentations.  Visit the ICLIO website for practical resources to help the multidisciplinary team with real-world issues in implementing immunotherapy for cancer.

Patient Navigation: How Patient and Family Focus Groups Can Help

By Tricia Strusowski, MS, RN

ThinkstockPhotos-484468581Seeking a great way to enhance your navigation program and best understand the specific needs of your patients and families? Consider conducting a patient and family focus group. I have always gotten the best feedback and ideas for our navigation program from hosting a patient and family focus group.  And I now incorporate focus groups sessions into many of my cancer program site visits. It is easy, fun, and the rewards are tremendous.  The patients and families are so appreciative that their input is sought after and valued.

What is a Patient and Family Focus Group?  

Focus groups are a form of qualitative research, discussions with your patients and families to learn about their healthcare wants, needs, and perceptions.  All great patient experience outcomes begin with listening to the voices of the patients and their families, relying on their perceptions of healthcare to identify priorities and enhance performance improvement initiatives that can yield amazing results.

Some Sample Guidelines for Facilitating a Patient and Family Focus Group

The following guidelines will help foster a robust, information-rich discussion:

  • Invite 8-12 participants of different race, ethnicity, age, gender, and cancer disease site. Invite their family members and/or caregiver, so that you can conduct a separate caregiver group at the same time.
  • Hire or invite an expert facilitator to run the sessions.
  • Choose no more than 10 carefully selected questions that allow for open dialogue.
  • Tape your session as well as invite a scribe to assist with notetaking. (Be sure to inform participants that you will be recording the discussion.)
  • Review focus group participation ground rules with all participants.
  • Provide a light snack and/or small thank you gift for participating in the focus group discussion.

Introduction and Ground Rules for the Focus Group 

Here are tips for getting the conversation started: 

  • Introduce yourself and ask each participant to introduce themselves.
  • Explain that the cancer program wants to know what they like, what they don’t like, and how they feel programs might be improved.
  • Remind the group that the cancer program leadership is interested in both negative and positive comments. 

Next, review the ground rules with your focus group members. Explain that the facilitator/moderator’s role will be to guide the discussion: 

  • Assure participants of complete confidentiality.
  • Emphasize that there are no right or wrong answers, only differing points of view.
  • Ask participants to please speak one at a time so the scribe can accurately capture the conversation.
  • Remind everyone that they don’t need to agree with each other, but it’s important to listen respectfully as others share their views. Everyone should feel free to share openly.
  • Request that everyone please turn all cellular phones to vibrate. If anyone needs to respond to a call, please do so as quietly as possible and rejoin us as quickly as you can.

Some Possible Questions for your Focus Group(s)

  1. What was important to you and your family as a newly diagnosed cancer patient?
  2. What is important to you and your family now that you have started your cancer treatment?
  3. Were you aware of the support services at the cancer center?  What services would you like at the cancer center?
  4. Was the patient journal and/or patient educational materials you received helpful? How could they be better?
  5. Patient- and family-centered care is extremely important, what does this mean to you and your family?
  6. What is important to you and your family in a survivorship program?

Once your focus group is complete, consider keeping the momentum going by creating a Patient Caregiver Advisory Committee.  Learn more in this recent Oncology Issues article that explores how improving patient engagement can help to improve your cancer program.

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

Financial Advocates: Sharing Insights & Strategies

By Joseph Kim, MD, MPH, MBA

ThinkstockPhotos-507273299Last week nearly 100 financial advocates gathered in Philadelphia, Pennsylvania, for the September 29 ACCC Financial Advocacy Network (FAN) Case-Based Workshop.  Whether from academic research cancer centers or community hospitals or practices, participants unanimously agreed that the entire cancer community needs to invest more resources to improve financial advocacy services in cancer programs throughout the country.

During the workshop, participants discussed the practical challenges they face every day and shared creative approaches to helping cancer patients experiencing financial hardships.  These included:

Navigating the Maze around Medicare. Open enrollment for Medicare starts October 15 and runs through December 7. This period is often a confusing time for Medicare enrollees and family members as they navigate the maze of options surrounding their healthcare coverage. During the workshop, participants discussed the pros/cons of Medicare Advantage for cancer patients and also touched on certain types of special enrollment periods (SEPs) that may open up based on unique circumstances.

For patients on Medicare with no supplemental coverage (i.e., no Medigap insurance), out-of-pocket responsibilities are to “typically pay 20% of the Medicare-approved amount for most doctor services.” When it comes to paying for the costs of treatment they are about to receive, these cancer patients are effectively underinsured. The resulting high out-of-pocket burden often leads to cancer patients to filing for personal bankruptcy.

Workshop participants agreed that cancer programs must take a more proactive approach when they see that a new patient on Medicare has no supplemental coverage. Hospital financial counselors often know to meet with such patients. Similarly, outpatient cancer programs must be sure to have reliable processes that trigger financial counseling referrals as soon as underinsured patients enter the system.

Another area of agreement: Cancer programs need to spend more time training their internal staff about the complexities surrounding Medicare coverage. Many consumers continue to confuse Medicare Advantage (also called Medicare Managed Care, Medicare Part C) and Medicare Supplement (also called Medigap or Medicare Select). A Medicare Supplement policy is different from a Medicare Advantage Plan. Medicare Advantage (MA) plans are ways to get Medicare benefits, while a Medigap policy only supplements an individual’s Original Medicare benefits.

Patient-Friendly Billing. Although financial advocates in cancer programs typically do not work in the hospital’s billing department, they may still be able to influence the type of billing process patients may experience.  According to the Advisory Board Company, the average American has $1,766 in overdue medical debt. Several workshop participants described how they have been offering different loan programs for their cancer patients. Some financial institutions offer patients 0% interest loans and affordable monthly payments. One such program offered by many hospitals is run by ClearBalance, and this program has been shown to reduce bad debt and increase patient collections. Other similar programs are designed to achieve a friendly billing process for patients who are already experiencing a tremendous amount of psychological stress and financial hardship.

Playing an Active Role in the Care Team. Many financial advocates and financial counselors have formal training in social work or financial services, but some also come with a clinical background in nursing. At some programs, pharmacy technicians are also assuming the financial advocate role, focusing on finding assistance programs around oral oncolytic agents. Given that financial advocates and counselors often have diverse backgrounds, they can learn from one another and from members of the clinical care team. By playing an active role as a member of the cancer care team, financial advocates can help inform key decisions around the course of treatment and potentially improve the patient’s outcome around important psychosocial factors such as financial toxicity. In many cancer programs, financial advocates may not see themselves as integral members of the care team, but this culture is changing.  Today, more financial advocates are attending tumor boards and speaking with clinicians to offer insights and assistance.

Since cancer care is rapidly evolving, hospitals and other cancer programs in the community must be properly equipped to ensure that patients receive the appropriate guidance and assistance as they prepare to start their treatment journey. Navigating the financial decisions around health insurance coverage remains confusing and many patients need help finding and applying for assistance programs.

ACCC Financial Advocacy Network (FAN) Resources

ACCC remains committed to providing ongoing financial advocacy resources in 2017. Based on member feedback, ACCC has been developing an online Financial Advocacy Certificate Program that will launch in 2017 and members will be able to access these modules on the ACCC eLearning portal. Stay tuned for more details as ACCC continues to expand its Financial Advocacy Network (FAN) program and be sure to visit often for the latest resources and updates from ACCC. Look for the 2017 ACCC Patient Assistance and Reimbursement Guide coming in January 2017.

Guest blogger Joseph Kim, MD, MPH, MBA, is president of Xaf Solutions. Dr. Kim served as facilitator for the Philadelphia ACCC FAN Case-Based Workshop.


Policy Summit Focuses on Biosimilars & Molecular Testing

By Brittney Fairman, Policy Analyst, ACCC

On Friday, September 16, the National Comprehensive Cancer Network (NCCN) held a policy summit at the National Press Club in Washington, D.C., on Developments in Biosimilars and Molecular Testing. ACCC was in attendance to hear oncology experts from across the country discuss topics ranging from the clinical implications to the regulation of biosimilars and molecular testing in oncology.

Discussions at the summit  also touched on the latest developments, trends, and future implications for both biosimilars and molecular testing, as well as maximizing patient outcomes and overall readiness for real-world applications in the clinical setting.  Look for an article from NCCN on the summit in the coming months.

Across the summit presentations some overarching themes surfaced regarding biosimilars and the rapid developments in molecular diagnostics. In both areas, key discussions revolved around quality, utility and cost, with implications created by many factors including regulation policies, disjointed and disconnected data, patient expectations, and nuanced reimbursement issues. Three key takeaways centered around:

  • The importance of developing methods for capturing data in novel ways and improving on EMR information linking to create a data warehouse to aggregate quality outcomes data. Ultimately, these data could be used to support best patient outcome decisions.
  • The imperative to achieve collaboration from all stakeholders to foster robust investments in resources to enhance science and information technologies.
  • The need to revise payment paradigms to appropriately account for the total cost of care.

In general, policy arguments over biosimilars will eventually narrow as biosimilars begin to be looked at more and more as nearly generics. In turn, there will eventually be less cost in production, and regulations for clinical trials may begin to roll back. Finally, there will be an even bigger role for education for both patients and providers to level-set expectations and address current communication barriers.

There are real implications being created by the current structure of regulations, as they apply to both biosimilars and molecular diagnostic tests.  ACCC will be following developments closely and providing more updates as they come.

Meanwhile, for providers seeking to integrate molecular testing into practice, ACCC offers resources and tools for process improvements for molecular testing in the community setting.  Learn more.



Cancer Registars: Is Concurrent Abstracting that Scary?

by Holly J. Kulhawick, CTR

ThinkstockPhotos-180686516Concurrent abstracting is the process of completing the cancer registry abstract in stages after each treatment occurs, rather than all at one time, four to six months after diagnosis. Some registries have always abstracted concurrently, but others are finding—or at least feeling as if—they are being forced into concurrent abstracting by the new Commission on Cancer (CoC) requirement to submit to the Rapid Quality Reporting System (RQRS). RQRS is a reporting and quality improvement tool that provides real-time clinical assessment of hospital-level adherence to quality of cancer care measures. On January 1, 2017, participation in RQRS will become mandatory for all CoC-accredited cancer programs.

Facing Down the Fear

Recent discussions on the National Cancer Registrars Association’s Facebook page indicate a high level of anxiety among those converting to concurrent abstracting. As with all fears, this one is best dealt with by facing it down and examining it under a bright light. Is concurrent abstracting really that difficult? No. Does it take more time? Sometimes. Cancer programs implementing concurrent abstracting for RQRS, can use resources on the RQRS website to help with updates and data quality assurance. CoC-accredited facilities can log on to CoC DataLinks to access their RQRS data. The password-protected site provides monthly alerts on the patients submitted to RQRS as well as updates on the treatment administered, offered, or recommended.

As CTRs embark on concurrent abstracting, they need to release the mantra that it has no advantages. Instead, recognize that this is the best way to provide quality, up-to-date cancer data, and accept the challenge. A major concern when converting to concurrent abstracting is who completes the updates. Certified Tumor Registrars (CTRs) are fiercely territorial regarding their work. This is not a helpful position to take when conducting concurrent abstracting. It is important to allow different members of the team to take turns updating the cases. In doing so, registrars may find that two sets of eyes are better than one at spotting errors or capturing all the nuances of a case. This can also prove to be an advantage in improving data quality and fostering teamwork.

Another concern is the need to return repeatedly to cases to provide treatment updates. To many CTRs, this seems like a doubling of the work. It does increase the time in certain abstracts, but the improvement in quality can be an offsetting factor. Think about it. How many times is an abstract seen only once? Not many, since in many large cancer registries the tasks are assigned to different staff members. One person may load the case and another may add surgeries and biopsies. Some registries use an automated system to load radiation or chemotherapy data with a staff person conducting follow-up months later. This same type of work plan can be used for concurrent abstracting. Allowing several staff to construct and review the abstract can also assist with quality assurance (QA). If only one person is assigned to conduct QA, they may be less attentive. If they know others will be reviewing the abstract, they may be more conscientious.

Data Clinicians Want and Need

Physicians have long complained about the latency of cancer registry data. Concurrent abstracting and RQRS help to address their concerns. Cancer registrars must respond. The cancer registry data does take too long to collect and to be put to use. Today, everyone wants instant results and oncology is no different. Any patient’s case can spiral out of control over a matter of days. Clinicians want to be able to monitor and respond as close to real time as possible. If it takes cancer registrars four to six months to even start a case, they are not providing clinicians with the data that they want and need—data that helps ensure high-quality cancer treatment and care.

Programmatic Benefits

The cancer registry department also benefits from concurrent abstracting. In addition to physicians valuing real-time data, your facility’s Finance and Administrative departments will too. They can analyze the data to help improve operations and services. As a result, these departments see the cancer registry fulfilling a vital need for the organization. This can often lead to more timely responses to requests for budget items, IT support, and additional staff. The cancer registry database can also be used to prepare tumor conference presentation forms. In many facilities, the completion of these forms is very involved, requiring registry staff to create the equivalent of an abbreviated abstract. This is a drain on staff time, since most tumor conferences occur monthly. With concurrent abstracting, the timely data can be merged to populate the forms, reducing the time to just minutes per form. Clinical staff appreciate the results and the doctors no longer need to haul office medical records to tumor conferences.

A near-to-real-time cancer registry database can also help in preparing Survivorship Care Plans (CoC Standard 3.3). To assist with these plans, cancer registry departments may want to consider educating nurse navigators on the database and providing them access so that they can update chemotherapy and/or offsite treatments. Sharing the database will not only help with these important plans, but will also foster a sense that the registry belongs to the team, not just CTRs.

Moving to concurrent abstracting may seem daunting—and, yes, even scary—but it’s an important step that can support and advance the work of the entire cancer care team.

Guest blogger Holly J. Kulhawick, CTR, is Supervisor, Cancer Registry, at ACCC Cancer Program Member Renown Health in Reno, Nevada.

Patient-Centered Approaches to Improving Population Health


by Susan van der Sommen, MHA, CMPE, FACHE

Crowd of multidisciplinary people-for webAn increasingly prevalent term in our health-related vocabulary is “population health.”  Every journal or health-related article uses the term as if it is widely understood. So what is it, really? How will we measure it and, more importantly, improve it?

The oft-quoted article by Kindig and Stoddart (2003), “What is Population Health?”  defines population health as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”  Whereas others have also sought to define the term, in my readings and research, I have yet to come across a more comprehensive—yet startlingly straightforward—explanation.  In his paper, Population Health in the Affordable Care Act Era, Michael Stoto, PhD, notes that despite differing definitions, the term “population health” is seen by many as an opportunity to connect healthcare delivery systems with community-based organizations, public health departments, and other entities to reach community members that may not access the traditional healthcare system effectively and/or receive the care they need.

Leaders at the Duke Cancer Institute  in Durham, North Carolina, have adopted a new approach to research and patient-centered care; that is, collaborating with local community members and groups to improve education, outreach, and access for their most disparate – and often underserved – populations. Their patient-centered approach, designed to assess and respond to community needs, increase participation in clinical trials (particularly for minority populations), and mitigate care gaps, is being implemented as part of a five-step strategic plan. At the core of the plan is the development of a Community Advisory Council, inclusive of community partners and patients, and the broad dissemination of findings in their robust community needs assessment. Resulting from these two initiatives was a prioritization of program and research activities with further development of programs and partnerships focused on the highest priorities defined by the council’s work. Of course, measurement and evaluation is at the core of all population health initiatives – and is the fifth component of Duke Cancer Institute’s strategic plan. Learn more.

The Duke Cancer Institute is seeking to meet the health needs of their population in a manner that is pertinent to all cancer centers and healthcare organizations. Defining a population’s needs through community partnerships and patient involvement is the key to being able to measure and ultimately improve health outcomes.

In a more widespread population health initiative,  ACCC has recently launched its Optimal Care Coordination Model for Lung Cancer Patients on Medicaid project with support from the Bristol-Myers Squibb Foundation. Research shows that minority and socio-economically disadvantaged individuals have higher incidence of cancer, are diagnosed at a later stage, and have a higher mortality rate. To address this unmet need, ACCC is currently partnering with five ACCC-member programs located in different geographic regions throughout the U.S. These programs are serving as Development Sites, helping ACCC document the current state of care coordination for Medicaid patients with lung cancer. This will help inform draft principles for development of a model for a more comprehensive, evidence-based approach to care coordination, access, and health equity for Medicaid patients with lung cancer. Read more about this exciting initiative in the September/October issue of Oncology Issues.

Make plans to attend the 2016 National Oncology Conference  in St. Louis, Missouri from October 19-21 to learn best practices from your colleagues at cancer programs across the country.

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