Category Archives: Across the Nation

ACCC Members Bring Sun Safety Awareness to their Communities

by Amanda Patton, ACCC Communications

453142595May is designated as Skin Cancer Awareness Month and the National Council on Skin Cancer Prevention has named today “Don’t Fry Day” to encourage sun safety awareness.

As we head into the summer, community swimming pools open, families and friends gather for picnics and barbecues, and thousands head to beaches and lakes for fun in the sun. Recent statistics from the American Academy of Dermatology (AAD) make clear the critical need to keep sun safety on everyone’s radar screen:

  • Estimates are 1 in 5 Americans will develop skin cancer in their lifetime
  • 8,500 people in the U.S. are diagnosed with skin cancer every day
  • Melanoma rate in the U.S. have doubled from 1982 to 2011

This month and throughout the year, ACCC Cancer Program Members and their staff play an important role in educating their communities on skin cancer prevention, early detection, and screening. For example:

In Delaware, Christiana Care Helen F. Graham Cancer Center schedules free Skin Cancer Screening Awareness programs just ahead of the Memorial Day weekend. The evening education sessions—offered in both English and Spanish—include information on self exams, risk factors, and how to protect yourself and your family. The programs use AAD materials and also promote a Delaware state skin cancer education and awareness program.

In Maryland, at Atlantic General Hospital, Regional Cancer Care Center, skin cancer awareness activities during the month of May include a digital display slide on hospital lobby TVs calling attention to the need for farmers to stay skin safe; Facebook posts with sun safety tips and resources; and free skin checks by Atlantic General Dermatology at the Annual Ocean City Health Fair.

In Idaho, St. Luke’s Mountain States Tumor Institute, developed the POOL COOL program to bring sun safety education to community swimming pools.

Each year, Skin Cancer Awareness Month serves as a call to action, an opportunity to spread the message on sun safety and skin cancer prevention. ACCC thanks all of our member programs and their multidisciplinary care providers for their efforts in May—and throughout the year—promoting health in their communities through education on prevention, screening, and early detection.

Reaching Out, Serving Our Communities

One in an occasional blog series on topics from Oncology Issues, the journal of the Association of Community Cancer Centers.

by Susan van der Sommen, MHA, CMPE, FACHE, ACCC Editorial Committee Chair

The words community on a bulletin boardDue to mandates in the Affordable Care Act (ACA) and revised Commission on Cancer standards, community outreach programs have become more prevalent in recent years with an enhanced mission of reaching community-dwelling consumers who do not utilize the healthcare system in a manner that is effective for achieving optimal health outcomes. ACCC-member programs play an important role in these efforts, and are actively engaged in outreach initiatives as varied as the populations they intend to reach. Here are just a few examples.

Grant Medical Center in Columbus, Ohio, winner of a 2012 ACCC Innovator Award, launched a Convenient Care Mammography Program aimed at providing mammography to working women on their lunch breaks. The program removes excuses that women often make to avoid getting their annual screenings—from “I’m too busy” to “the timing is not convenient”—by providing a streamlined, time-efficient process, convenient scheduling, and even transportation!

Since 2006, St. Luke’s Mountain States Tumor Institute, a multi-site cancer program serving southern Idaho, eastern Oregon, and northern Nevada, has been developing community-based approaches to youth-based prevention education programs that address such issues as tobacco use, sun safety, and healthy lifestyle habits.

To better serve its community Klabzuba Cancer Center at Texas Health Harris Methodist Hospital Fort Worth employs two mobile health coaches with full examination facilities, as well as mammography suites to bring screening services and education to work sites and rural locations, removing barriers to care access. To provide these services, this 2013 ACCC Innovator Award winner has partnered with businesses, government agencies, and other local organizations.

The Bassett Cancer Institute with its flagship site in rural Cooperstown, New York, began a cancer screening outreach program in 2008, which in 2014 won the HANYS Community Health Improvement Award.  Recognizing that the socioeconomic status, geography, and lack of effective public transportation in their eight-county region impacts the ability of patients to access preventive services, the mobile coach, which was constructed with a digital mammography and a self-contained clinical unit, travels to a variety of community-based sites, enabling staff to reach more underserved people with mammograms, clinical breast exams, Pap smears, and colorectal cancer screenings than through routine office visits.

The cover story of the May/June 2016 edition of Oncology Issues highlights Christiana Care’s Community Health Outreach and Education Program, which takes community outreach to a new level by incorporating a tailored approach designed to reach a culturally diverse population in a manner that is comfortable and welcoming.

The American Journal of Preventative Medicine notes that “cultural competence in an individual or organization implies having the capacity to function effectively within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.”

Christiana Care’s outreach and education program was designed with the inherent understanding that a “one size fits all” or “open our doors and they will come” approach will not always work—particularly with disparate populations. Their solution? Set up shop in the local farmer’s market where more than 75 culturally diverse vendors sell their products. Christina Care’s concerted effort to employ multicultural, bilingual staff and deploy the team in a non-traditional venue where they are guaranteed to reach the population is not only innovative, but also very effective.  Where better to reach a population than in a place where they already come together both for work and pleasure?

According to the Institute of Medicine report, Health Literacy: A Prescription to End Confusion, health literacy is defined as “the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions.” The same report notes that nearly half of all American adults—90 million people—have inadequate health literacy to navigate the healthcare system. Inequitable delivery of care and the resulting disparities affect the overall health and well-being of individuals in a manner that may ultimately result in a public health concern.

The farmer’s market outreach and education program developed by Christiana Care is a successful formula for ensuring that education and outreach occurs not only within the communities it serves, but also in a manner that speaks to patients—quite literally—in a language they can understand.

 

 

Key Takeaways from Congressional Hearing on “Medicare Drug Experiment”

By Brittney Fairman, Policy Analyst, ACCC

Capitol BuildingOn Tuesday, May 17, the U.S. House Energy and Commerce Committee Subcommittee on Health held a hearing titled “The Obama Administration’s Medicare Drug Experiment: The Patient and Doctor Perspective,” which focused on CMS’ proposed Medicare Part B Drug Payment Model. The Subcommittee heard from witnesses representing the provider and patient communities, including:

  • Debra Patt, MD, MPH, MBA, Vice President of Texas Oncology and Medical Director of The US Oncology Network;
  • Marcia Boyle, President and Founder of the Immune Deficiency Foundation;
  • Michael Schweitz, MD, FACP, MACR, National Advocacy Chair of the Coalition of State Rheumatology Organizations;
  • Heather Block, a patient advocate; and
  • Joe Baker, President of the Medicare Rights Center.

Notably, the hearing echoed many of the concerns ACCC and fellow stakeholders have been voicing since CMS released the proposal in early March. Key takeaways include:

CMS is operating under a false premise that there are always less costly therapeutic equivalents available to treat patients. In the case of oncology, treatment situations where there are true clinical substitutes are “few and far between,” Dr. Patt pointed out. When a therapeutically equivalent drug does exist, those drugs are not always available to every clinician nor are they always most conducive to a patient’s specific treatment plan.

The proposed demonstration will create barriers to patient access and have a disproportionate impact on rural areas. With a lack of appropriate safeguards, healthcare providers fear the demonstration program would create additional financial pressures that would push rural or small physician practices out of business.  For patients in rural areas – or patients that require more expensive therapies – this may cause difficulty in accessing oncology care.

CMS’ proposal is akin to an involuntary clinical trial. Witnesses and Committee members pointed out that CMS’ experiment is not unlike a clinical trial, requiring participation of providers and their patients for the purposes of data collection. However, unlike a clinical trial, participation is involuntary and the proposal lacks critical patient safeguards – patients may never know if their provider is operating under a control or experimental arm of CMS’ demonstration. This randomized trial will, unknowingly and unwillingly, limit patient access to needed care.

Average Sales Price (ASP), by definition, is an average. Many community oncologists – often smaller practices – are not able to gain price advantages and are currently paying well above ASP for Part B drugs. Any further reductions to reimbursement will make it impossible for providers to cover the acquisition cost of many, if not most, cancer treatments.

Witnesses also addressed a series of “carve-outs” that have been discussed by policymakers, including for oncology providers, the Oncology Care Model (OCM) participating practices, or rural providers. Dr. Patt, however, pointed out that “there’s no right way to do the wrong thing.” Most witnesses called for a full withdraw of CMS’ proposal.

These points and more can be found in ACCC’s comments, submitted to CMS in early May. ACCC is continuing to monitor Congressional efforts on the CMS proposal.

Financial Advocates: Helping to Close the Gap

Amanda Patton, ACCC Communications

Hands-creating-circle-of-supportThe just-released 2016 CancerCare Patient Access and Engagement Report provides the oncology community with a comprehensive look at cancer patients’ perspectives of real-world issues that accompany patients along the care continuum from diagnosis through treatment and beyond. The landmark study encompasses six surveys capturing responses from 3,000 cancer patients representing a broad diversity of ethnicity, income, education, geography, age, insurance, cancer type, and treatment stage.

Cancer program staff who serve as financial advocates helping patients navigate the economic challenges cancer brings will not be surprised by the results of Survey 4: Financial and Insurance Issues. Among the survey’s key findings:

  • Only about half of respondents report understanding their health insurance coverage for their cancer care “completely” or “very well.”
  • 58% of respondents reported being distressed about their finances during treatment.
  • 20% to 30% of patients reported having trouble estimating their out-of-pocket costs before incurring medical expenses.
  • To afford treatment, one-third of respondents (ages 25 to 54) reported cutting back on daily necessities, including groceries and transportation, and/or borrowed from family members and friends.

As these findings show, financial toxicity remains a top-level issue for patients with cancer, and the need to close the gaps in addressing the economic impact of cancer on patients and their families is critical.

At many cancer programs today, financial advocates are helping to close these gaps by:

  • Helping patients understand the costs of care;
  • Facilitating pre-authorizations and pre-certifications;
  • Connecting patients with patient assistance programs, copay support programs, and foundation support;
  • Accessing community resources to meet patient financial needs, and more.

The ACCC Financial Advocacy Network (FAN) is a partner in this effort bringing training, resources, and peer-to-peer support to oncology financial navigators and advocates.  The  Financial Advocacy Network (FAN) Case-Based Workshops bring these professionals together to share effective practices and strategies for the evolving healthcare coverage landscape, and to join in collaborative problem solving.  Learn more and view upcoming workshop schedule here.

ACCC Voices Part B Demo Concerns on Capitol Hill & at CMS

By Amanda Patton, ACCC, Communications

ACCC-PartB-Demo-Meeting-Capitol Hill-crop2With the Medicare Part B Drug Payment Model comment deadline fast approaching (Monday, May 9 at 5:00 pm EDT), ACCC continued its push to educate policymakers on the detrimental impact this ill-conceived proposal will have on community cancer care, providers, and patients.

This morning ACCC President Jennie R. Crews, MD, MMM, FACP;  ACCC Past President Ernest Anderson Jr., MS, RPh, FASHP; and Leah Ralph, Director of Health Policy, ACCC; together with representatives from the Hematology/Oncology Pharmacy Association (HOPA) and the Oncology Nursing Society (ONS), traveled to Capitol Hill to meet with Senate Finance Committee staff and discuss concerns about the Part B proposal’s impact on cancer care. During the meeting, ACCC shared information from a data analysis that reveals the significant financial impact the proposal would have on providers and patients.

In a meeting with CMS Center for Medicare and Medicaid Innovation (CMMI) staff on Monday afternoon, ACCC leadership, along with representatives from HOPA, and ONS—reflected the voice of multidisciplinary cancer care providers.  ACCC shared results from the Part B proposal data analysis and reiterated ACCC’s strong concerns that are reflected in our comment letter to the agency.  Read our comment letter.

Stay tuned for advocacy updates from ACCC.

 

ACCC Supports H.R. 5122, Legislation to Prohibit Medicare Part B Drug Demo

By Leah Ralph, Director of Health Policy, ACCC

Capitol BuildingThe Association of Community Cancer Centers (ACCC) thanks Representative Larry Bucshon (R-IN) for introducing H.R. 5122, legislation to prohibit further action on the Centers for Medicare & Medicaid Services (CMS) proposed rule for the Medicare Part B Drug Demo. ACCC urges prompt passage of H.R. 5122 in the U.S. House of Representatives.

ACCC remains strongly opposed to the Part B Drug Demo and is deeply concerned about the potential impact of this misguided proposal on both providers and the patients they serve.

Our membership, comprising approximately 2,000 practices and hospitals across the country, is committed to implementing value-based reforms and to continuing to work with CMS on meaningful payment reform—our members will be participating in the CMMI Oncology Care Model and investing in the infrastructure needed to comply with MACRA. However, CMS’ Part B Drug Model proposal is a nearsighted approach to Medicare reform.

ACCC supports H.R. 5122, and a full withdraw of the program, to provide the oncology community and CMS time to fully understand the impact of this policy and to work with CMS on meaningful reform.

For more on ACCC advocacy efforts on this issue, visit accc-cancer.org.

ACCC Asked: Congress Listened

By Leah Ralph, Director of Health Policy, ACCC

time for actionToday 242 members of Congress joined in a bipartisan letter to CMS Acting Administrator Andy Slavitt urging the agency to withdraw its proposed Medicare Part B Drug Payment Model.  The effort was spearheaded by House Ways and Means Committee Member and Budget Committee Chairman Tom Price, MD (R-GA), House Energy and Commerce Committee Member John Shimkus (R-IL), and House Ways and Means Committee Charles Boustany Jr., MD (R-LA).

You asked and Congress listened.  Last week, hundreds of ACCC members reached out to their legislators asking that they sign on to the Congressional letter to CMS.  ACCC thanks its membership from 2,000 cancer programs and practices across the country for speaking up and telling their legislators about the detrimental impact this proposed rule would have on their patients and providers.

But the question remains: Will CMS listen?

May 9 is the deadline for comments to CMS on this misguided proposal. ACCC will be submitting comments to the agency and urges its members to send comments as well.

Learn more about ACCC advocacy efforts on this issue here.

A Misguided Experiment?

By Leah Ralph, Director of Health Policy, ACCC

Centers_for_Medicare_and_Medicaid_Services_logoThe noise around drug costs seems to have gotten louder in recent months, with policymakers clamoring for controls on drug pricing, Congressional hearings calling on pharmaceutical executives to testify, and recommendations from the Medicare Payment Advisory Commission (MedPAC) focused on containing Medicare spending in the context of ever-increasing prescription drug costs.

In early March, the Centers for Medicare and Medicaid Services (CMS) issued a proposal to implement a national demonstration program that would target provider reimbursement and fundamentally change the way Medicare pays physicians and hospitals for Part B drugs. The scope of what CMS is proposing is sweeping. If finalized, it represents a significant departure from the methodology and philosophy underlying Medicare’s current reimbursement system, leading to bigger questions about the most appropriate—and effective—way to curb drug spending.

Mandatory Participation

 CMS has broad authority under the Center for Medicare & Medicaid Innovation (CMMI), created by the ACA, to test different models that would improve quality and lower costs in the Medicare program. However, the agency seems to be pushing the scope of its authority, breaking from past demonstration programs to propose a mandatory model in which all Part B providers–hospital outpatient departments, physician offices, and pharmacies–would be required to participate.

The proposed Part B Drug Payment Model would consist of two phases in which providers would be divided into four groups: three experimental groups and one control group over a five-year period. Phase I would be implemented as early as August 2016 and would mandate that approximately half of all Part B providers would have their reimbursement rates reduced to ASP+2.5% plus a flat fee of $16.80 per drug per day. Importantly, Congressionally-mandated sequestration will continue to apply to payments made under the model. As a result, under the proposal, the experimental group’s actual payment rate will be ASP+0.86% plus $16.53 per drug per day. The remaining half, the control group, would continue to be reimbursed for Part B drugs at ASP+6%. The goal, which policymakers have discussed for sometime, is to eliminate financial incentives for providers to prescribe more expensive drugs.

Ambitious Timeline

The agency’s ambitious timeline calls for Phase II to begin as early as January 2017. Phase II would further divide the control and test groups—creating a four-arm control trial—and overlay a requirement to use value-based pricing (VBP) reimbursement strategies and clinical decision support (CDS) tools to produce Medicare savings. One (unlucky) group of providers will be subject to both the reduced ASP rate and the requirement to utilize VBP tools. These tools might include:

  • Reference pricing: Medicare would set a standard payment for therapeutically similar products.
  • Indications-based pricing: Payment would vary for a drug based on its clinical effectiveness for different indications.
  • Voluntary-risk sharing agreements: CMS would enter into voluntary agreements with manufacturers to link health outcomes with payment.
  • Discounting or eliminating patient coinsurance to encourage beneficiary use of high-value drugs.

Unanswered Questions

Despite a preliminary list of potential tools, CMS failed to describe these VBP approaches in any meaningful detail, leaving many questions about how CMS will develop this methodology and how the agency will make determinations about high-value treatments.

Perhaps most unnerving, providers would be assigned to arms of the trial at random based on their geographic location in Primary Care Services Areas (PCSAs), which are clusters of ZIP codes that reflect primary care service delivery. Although CMS has structured Phase I to be budget-neutral for the Medicare program, among providers, there will be winners and losers: the program is designed to redistribute drug spending by increasing payments to provider specialties, such as primary care, that use relatively inexpensive drugs and decrease payments to hospitals and physician specialties, such as oncology and ophthalmology, that often use more costly drugs. Specifically, under the proposed model, the tipping point is $480–drugs that cost providers more than $480 per day on average would result in lower reimbursement, whereas products costing less than $480 per day would produce higher payments than what is reimbursed today.

The majority of drugs–7 of 10–that would make up the largest reduction in reimbursement are used to treat cancer. Moreover, many of these drugs do not have a lower cost alternative.1

ACCC Takes Action

 On both policy and process, ACCC remains deeply concerned. Rather than working with cancer care professionals to build the infrastructure needed to define quality and value in their cancer programs, CMS has responded to a call for reigning in drug costs with a myopic focus on reimbursement. Our members have partnered with CMS on meaningful payment reform – including the most recent Oncology Care Model – and will soon be dedicating extensive resources to navigating a new, and complex, reformed physician payment system under MACRA.

Oncologists are ready for change, but CMS’ proposal reaches too far, too fast, with seemingly little understanding of the devastating impact this approach will have on community cancer care and patient access.

Early on, ACCC joined with 60 oncology stakeholder groups in a letter to CMS asking the agency to withdraw its proposal. On March 17 ACCC, together with more than 300 state and national organizations, sent a letter to Congress asking policymakers not to move forward with the CMS Part B Drug Payment Model proposal. We recently partnered with the Hematology/Oncology Pharmacy Association (HOPA), the Oncology Nursing Society (ONS), and the Association of Oncology Social Work (AOSW) to caution Vice President Biden about how the proposal would impede the goals of the Administration’s cancer Moonshot initiative.

CMS will accept comments on the proposal until May 9, 2016. ACCC will be submitting a comment letter and urges members to express their concerns to the agency.

Access ACCC resources related to this issue and learn more about our advocacy efforts here.

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This post was updated on April 26, 2016.

Ready or Not. . . More ICD-10-CM Codes Coming October 2016!

By  Cindy Parman, CPC, CPC-H, RCC

Calendar pages and clockThe transition to ICD-10-CM diagnosis coding occurred October 1, 2015, but just like ICD-9-CM we will be seeing additions, deletions and revised codes each October until the U.S. moves to ICD-11-CM. Prior to the ICD-10-CM implementation, there was a code freeze and the code set remained in stasis. Beginning October 1, 2016, that changes. Although the final list of codes that will be effective on that date has not yet been published, there are potentially 1,943 new codes, 422 diagnosis codes with revised definitions, and 305 codes that will probably be deleted.

The public comment period for these planned updates closed on April 8, 2016. Both the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) will review all comments before issuing the final list of new, revised and deleted diagnosis codes in June 2016.

Proposed ICD-10-CM changes that will affect oncology include:

  • The addition of more codes to describe the anatomic sites of gastrointestinal stromal tumors
  • The revision of code definitions for Hodgkin lymphoma
  • Code additions for Castleman disease, mast cell activation syndrome and a specific code to report “Rising PSA following treatment for malignant neoplasm of prostate.”

In many instances an existing ICD-10-CM code will be deleted effective October 1, 2016, and replaced by multiple, more specific diagnosis codes. For example, the code for “Acute vascular disorders of intestine” will be deleted and replaced with 27 more specific diagnosis codes.

The ICD-10-CM Official Guidelines for Coding and Reporting, as well as code update information is located at: http://www.cdc.gov/nchs/icd/icd10cm.htm.

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Guest blogger Cindy Parman, CPC, CPC-H, RCC, authors the “Compliance” column for Oncology Issues, the journal of the Association of Community Cancer Centers.  She is a principal at Coding Strategies, Inc., in Powder Springs, Ga. Attend an ACCC Oncology Reimbursement Meeting to stay current with the latest trends and updates in oncology coding and reimbursement.

Patient Navigation: 20 Years in Review & My Lessons Learned

by Tricia Strusowski, MS, RN

Patient Navigation Compass for HealthcareIt is amazing how the world of patient navigation has changed over the last 20 years! Fate has aligned me with many wonderful opportunities, and over the years I’ve been honored to be an active participant both in the navigation role itself and in navigation program development. The journey has been a labor of love, a true passion, and extremely gratifying.

I was first introduced to the concept of navigation through my role in case management in the mid-1990s. Identifying the needs of the patients even before their cancer care commenced became a necessity to help transition the patients to the correct level of care. The goal was to provide the best services, decrease duplication of care, contain costs, and increase communication among the healthcare team. The patient and the family were active participants in their plan of care.

Toward the end of the decade, in 1998, my then-employer, Christiana Care Health System, Helen F. Graham Cancer Center, identified the need for “care coordination” for oncology patients and families (navigation was not yet a familiar term). We were one of the earlier adopters of “care coordination” or what we now call navigation. Our team consisted of disease-site-specific oncology nurses and social workers. We were under the “administrative microscope” to coordinate care across the continuum from cancer diagnosis through end of treatment or end-of-life care. After a bumpy start, we developed and then standardized our program.  We created pathways, guidelines, standing order sets, a patient journal, and patient tools, which are now called decision aids.  Learn more here.

Here are some navigation lessons learned over the years.

Lesson learned #1: Create tools and reports to reflect American College of Surgeons Commission on Cancer (CoC) national standards; identify metrics to demonstrate the success of your program. Define your reports and metrics for the staff so that information/data is collected in a consistent manner. 

As a new navigation program we initially made our patients and families too dependent on our services and as our volume increased, the caseloads became unmanageable. The staff became overwhelmed and we needed to address this immediately to provide the best service for our patients.

Lesson learned #2: Empower your patients with decision-aid tools/educational materials and provide health literacy training for staff. Monitor the caseloads and close cases when active treatment is completed. Hold morning meetings or huddles to share patient information with the healthcare team across the continuum.  Keeping your healthcare team updated increases productivity. 

In 2007 Christiana was an original member of the NCI Community Cancer Centers Program (NCCCP) initiative. I co-chaired the Quality of Care Subcommittee.   As a result of navigation discussions we created the Navigation Networking Committee and listserv; we held monthly conference calls to discuss our programs, best practices, document tools, and models of navigation. Our committee grew to more than 90 attendees. It was a fantastic learning and bonding experience; many of us are still close colleagues today. One resource developed through the NCCCP was a Navigation Assessment Tool for growing a program. Learn more.

Lesson learned # 3: Collaborate with your internal and external resources to identify best practices. Use the internal resources/experts in your healthcare system, i.e., pastoral care, finance, volunteer department, etc.  Partner with your external resources, such as the American Cancer Society (ACS), state Breast Cancer Coalition, Leukemia & Lymphoma Society, and Cancer Support Community. 

From 2008 to 2009 ACCC provided me with an exceptional opportunity to teach a two-day patient navigation workshop at six community cancer programs. I met with the teams and we discussed the goals, roles and responsibilities, documentation tools, job descriptions, guidelines, reports, and performance improvement initiatives. The programs were all very appreciative of the information because there really were not many resources available at the time. At the end of these training sessions ACCC held its first webinar on navigation.

Lesson learned # 4: Don’t reinvent the wheel. Today there are many resources available for navigation through ACCC, AONN+, ONS, AOSW, NCI, IOM, and  ASCO, just to name a few.  Network with your colleagues via listservs.

Navigation at times can be a “catch all” service; navigators may get bogged down with scheduling appointments, calling insurers, and data entry as well as other clerical duties.  Although some of these responsibilities are inevitable, it is important to identify support staff to assist with these tasks.

Lesson learned # 5: As a professional navigator it is essential that you function to the top of your license. You don’t want to turn into an expensive clerk.

Today, as I continue my role as independent consultant, I always tell my clients that patients and families always come first. If you take excellent care of the patients using national standards and best practices, the rest will fall into place.

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