Tag Archives: Oncology Issues

Staying the Course: The Role of Oral Oncology Nurse Navigators

By Virginia Vaitones, MSW, OSW-C

The development and use of oral agents in treatment for oncology and blood disorders has exploded over the last decade and half. Today, these agents bring many benefits to patients and cancer care staff, but along with those benefits come challenges.

Then . . . and Now
Thinking back to 2001, for example, when capecitabine, the first oral chemotherapy for the treatment of metastatic colorectal cancer was approved, Medicare covered 80% and the beneficiary’s co-insurance was 20%. A patient could simply take the prescription to the local pharmacy and get it filled. The relatively modest financial impact and the ease with which the patient could access the medication made me excited about the use of oral agents. And at the time, there was much discussion about oral agents being the treatment of choice in the future.

Nearly two decades later, we now have more than 50 U.S. Food and Drug Administration-approved oral anticancer agents.  Over that same time span, as we all know, our healthcare landscape has become increasingly complex, as have our anti-cancer therapeutic regimens. Currently, capecitabine is 1 out of only 5 oral chemotherapy that is covered by Medicare at 80%. Patients and providers today often face challenges in accessing and affording costly new oral agents. Patient understanding of and adherence to complex treatment regimens can also be a barrier to effective treatment. As a result, ensuring quality care for patients receiving oral agents often requires a coordinated effort by innovative and creative cancer practices and programs.

The September/October edition of Oncology Issues highlights two such programs. One program is a large physician practice in central New York with an in-house dispensary; the other is a large outpatient hospital network serving two states, Kentucky and Southern Indiana, also with an in-house dispensary. The first step for both was consulting with their stakeholders to identify how care needs to be delivered and monitored. In both instances, on-going patient support and education were identified as key in establishing trust and compliance with the patient and their caregivers. The answer for both programs? Creating an oral oncology nurse navigator program that ensures care coordination, provides a single point of contact for patients and providers, and has led to improved patient care and satisfaction.

As we engage in the complex delivery system of value-based, patient-centered care, the Association of Community Cancer Centers continues to develop tools and resources for cancer care providers seeking to implement or enhance their oral oncolytic programs. Explore peer-to-peer resources, including webinars, white paper, and patient education materials, available through the ACCC Education initiative Steps to Success: Implementing Oral Oncolytics.

Approximately 25-30 percent of the new cancer treatments in the pipeline are oral agents; cancer programs and physician practices will continue to need a well-coordinated team effort to ensure patient safety and satisfaction.


Virginia Vaitones, MSW, OSW-C, is a past president of the Association of Community Cancer Centers (ACCC)  and the Association of Oncology Social Work (AOSW). She is currently serving as chair of the ACCC Editorial Committee. 

The 34th ACCC National Oncology Conference, Oct. 18-20, offers the Oncology Pharmacy Education Network (OPEN) Pre-Conference, including a session on a comprehensive, collaborative, pharmacist-led oral chemotherapy program. Learn more here.  View the full conference agenda.

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.

Three Ways to Support Your Cancer Registrars

By Linda Corrigan, MHE, RHIT, CTR

Check boxCommission on Cancer (CoC) Cancer Program Standards 2016 are designed to ensure a comprehensive approach to the care and treatment of patients. Cancer programs seeking CoC accreditation must demonstrate that they’ve met or exceeded these standards—many of which require data tracking. Your cancer registrar can assist your clinicians in designing the best “tracking tool” for your program. For many programs, the best tool will be your cancer registry software. Cancer registrars well-versed in high quality data collection are key to the success of a cancer program. In turn, there are three critical ways your program can support its cancer registrars:

  • Make sure your cancer registrars are up-to-date by supporting training and continuing education opportunities. Change is a constant in the world of oncology. Treatments are advancing, CoC standards are added and/or revised, and state cancer registry data-collection guidelines are updated annually. A prime example of this constant change is the American Joint Committee on Cancer’s (AJCC) soon-to-be-released Cancer Staging Manual. The new 8th edition, scheduled for publication in October 2016, will revise how cancer is staged.
  • Encourage your cancer registrars to get involved in state and national organizations and provide funds for them to attend meetings and conferences. The key to helping your cancer registrar stay current is networking and continuing education. Some registrars have as many as three separate organizations and/or federal agencies that “set” the standards for exactly how and what data are collected from a facility’s cancer program. Cancer registrars who attend national conferences and state meetings or who are encouraged to volunteer for national and state-level organizations develop a network of colleagues from across the country that can be tapped as a resource when your program has questions.
  • Staff your cancer registry appropriately. The best way to support and retain your cancer registrar and to ensure high-quality data collection is to make sure you have the staffing bandwidth for the number of cancer cases your facility manages each year. Review NCRA’s Workload and Staffing Study: Guidelines for Hospital Cancer Registry Programs to help assess your staffing needs.

The National Cancer Registrars Association (NCRA) and the Association of Community Cancer Centers (ACCC) are two national associations that can help cancer programs support their cancer registrars. NCRA’s Annual Educational Conference provides a thorough and cost-effective way for cancer registrars to stay informed and to network. Attendees learn about updates to treatments and staging, CoC standards, clinical trials, and national trends. The 2017 conference, scheduled for April 5-8, in Washington, D.C., will focus on the AJCC’s 8th edition of the Cancer Staging Manual. Look for conference updates on the NCRA website here.  NCRA’s Center for Cancer Registry Education is a learning management system designed to provide easy access to high-quality educational programming. The website offers a variety of online products to help registrars tailor training and manage the continuing education credits needed to maintain their Certified Tumor Registrar (CTR) credential.

ACCC is also a great resource for cancer registrars. ACCCExchange, the association’s online member discussion forum, connects registrars with peer-to-peer solutions, strategies, and resources for how to best meet CoC standards. ACCC’s journal Oncology Issues provides in-depth articles on programmatic innovations implemented by ACCC member programs, coding updates, and advocacy issues—and can be a valuable resource for registrars to better understand advancements in cancer treatment and care. Coming in October, the ACCC 33rd National Oncology Conference in St. Louis will focus on practical “how to’s” for cancer programs and practices, with peer-to-peer learning on process improvement strategies, putting data to work to improve care, and more. Learn more here.

Contributing blogger ACCC member Linda Corrigan, MHE, RHIT, CTR, is president, National Cancer Registrars Association.

The Power of Sharing Your Story

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

Talking heads At the upcoming ACCC 33rd National Oncology Conference October 19-21, in St. Louis, Missouri, the 2016 ACCC Innovator Award winners will be showcasing their pioneering efforts aimed at improving the provision of care to cancer patients with initiatives that can be replicated in other community cancer programs.

Spreading the Word

In addition to speaking at the National Oncology Conference, every ACCC Innovator Award winner has the unique opportunity to write a feature article for Oncology Issues, ACCC’s bi-monthly journal.  The just-released July/August 2016 issue presents in-depth, “how we did it” articles from several of the 2015 Innovator Award winning programs. But opportunities for ACCC members to share their cancer program’s initiatives and successes are not limited to Innovator Award winners. Oncology Issues features insightful articles from ACCC member programs throughout the country – large and small. And every issue includes a “Spotlight” article profiling an ACCC Cancer Program member.

For instance, in the January/February 2016 issue, authors from two ACCC Cancer Program member institutions wrote about how to “Unlock the Potential of the Cancer Registrar,” describing the integral role their cancer registrars are playing in their organizations’ lung screening programs. And the May/June 2016 issue featured an article from ACCC Cancer Program Member The Valley Hospital’s Blumenthal Cancer Center on its Oncology Nursing Fellowship Program. In feature articles such as these, ACCC members share their real-world strategies for overcoming challenges and improving oncology care delivery, enriching the oncology community as a whole.

What better way to feature your cancer program’s success than through an article or profile published in a journal with national coverage? Many of our colleagues have used the opportunity to garner local media coverage in their respective markets; others have showcased their work among their peer group – which sometimes includes much larger centers.

In a recent ACCC Communications Survey, ACCC members were polled on the association’s journal, Oncology Issues:

  • 90% said that Oncology Issues is the “primary benefit of ACCC membership.”
  • 98% said that Oncology Issues “contains practical information, insights, ideas, and tools.”
  • 92% said that Oncology Issues “contains information that I do not find in other sources.”
  • 88% said that Oncology Issues “helps my cancer program stay ahead of the competition.”
  • 88% said that Oncology Issues is “must reading for me to stay ahead in my profession.”

What makes the Oncology Issues so successful? Input from ACCC cancer program members like you! To help spread the word to ACCC members about opportunities to contribute to the journal and how Oncology Issues’ content can be leveraged to benefit your program, this year’s National Oncology Conference will feature a new agenda item – “Oncology Issues Live!” hosted by members of ACCC’s Editorial Committee. Interesting in learning more about contributing or having your program featured in Oncology Issues? Want to be part of the Editorial Committee? Come to “Oncology Issues Live!” at the ACCC 33rd National Oncology Conference, October 19-21 in St. Louis, and connect with us.

 

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.

 

 

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.

Caring for the Whole Patient—Two Cancer Programs; Two Approaches

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

Hands-creating-circle-of-supportThe pivotal 2013 Institute of Medicine* report, Delivering High Quality Cancer Care: Charting a New Course for a System in Crisis, effectively outlines what those of us working in the cancer setting inherently know: More than 1.6 million patients are newly diagnosed with cancer annually; a number that is expected to rise to 2.3 million by 2030. The same report notes that by 2022, there will be 18 million cancer survivors in the U.S.

Cancer is indiscriminate. The newly-diagnosed are old, young, rich, and poor; fathers, mothers, daughters, sons, and siblings; they are single, married, bisexual, and gay; some are working, retired, on disability, or collecting social security. Two things these patients have in common are (1) they are people who are performing the activities of daily living—whatever  that may be—and  (2) cancer has changed their lives forever.

On a positive note, achievements in clinical science and treatment have led to earlier detection of many cancers, significantly increased life expectancy, and cured many of the disease. However, these same people may face other challenges often not detectable by the untrained eye: they are scared, anxious, depressed, and often suffering from considerable physical impairment that may dramatically impact their daily lives. As the 2008 IOM report Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs notes, these emotional, mental, and physical symptoms may be an exacerbation of issues the patient had prior to the cancer diagnosis.

The March/April edition of ACCC’s journal Oncology Issues includes feature articles that detail how two cancer programs have dramatically improved the lives of their patients (and patients’ caregivers) by instituting psychosocial distress screening and support programs. In their article, “Building a Navigation and Psychosocial Support Program from the Ground Up,” Lori McNulty, RN, and Faye Flemming, RN, BSN, OCN, describe how the Southside Regional Medical Center implemented a newly-developed patient navigation program as the foundation of their psychosocial support services. As with many cancer programs, Southside Regional Medical Center, though committed to furnishing these services, couldn’t justify the financial outlay needed to hire additional staff. By partnering with a local community organization, Southside Regional Medical Center was able to facilitate a patient-centered—and financially sustainable—approach to providing these vital services to their patients. Additionally, its  support program was established in such a way that the cancer program was able to meet many of the accreditation standards set forth by the Commission on Cancer.

The Norton Cancer Institute in Louisville, Kentucky, embedded a psycho-oncology program in its center to more effectively meet the needs of its patients’ psychosocial needs. Noting that psychological distress is common among cancer patients and often goes unrecognized, this ACCC member program developed the Norton Cancer Institute Behavioral Oncology Program (NCIBOP). As described in their article “Building Bridges, Breaking Down Barriers: An Embedded Psycho-Social Program Improves Patient-Centered Care,” NCIBOP is “a comprehensive, embedded psychiatric program with an emphasis on integrating high-quality psychiatric care to medically complex patients.” The program offers a multitude of group and individual therapy services and consultations in both the inpatient and outpatient setting. Staffed by three advanced practice RNs, a psychiatrist, a part-time social worker, a nurse, and two administrative staff, the team addresses the needs of approximately 800 patients per year. NCIBOP’s evidence-based, patient-centered approach has allowed many patients to experience a dramatic improvement in the quality of their lives.

Two cancer programs with two different approaches to meeting the cancer patients’ needs—these articles illustrate the complexity of oncology care delivery. At the same time, these divergent approaches also highlight the opportunity individual programs have to develop a programmatic structure designed to meet the needs of their unique patient population. The result? Patient-centric care models that meet the needs of the whole patient, just as the IOM report recommends.

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*Note: On March 15, 2016, the division of the National Academies of Sciences, Engineering, and Medicine (the Academies) that focuses on health and medicine was renamed the Health and Medicine Division (HMD) instead of using the name Institute of Medicine (IOM). For more information, visit www.nationalacademies.org.

Getting Engaged

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

ThinkstockPhotos-484468581When first hearing of a cancer diagnosis, I imagine a patient’s mind spinning with a cyclone-like ferocity … Am I going to die? How will I tell my family? What about all of my plans? It’s cancer … of course I am going to die … but how soon? Suddenly, life spins out of control.

Engaging patients in their care can dramatically reduce anxiety by giving back some control. Of course they can’t control the diagnosis, but they can control how they face it – on their terms, with their beliefs, wishes, and desires at the forefront of every decision.

In a recent Oncology Issues article, “Talk to Me: Improve Patient Engagement; Improve Your Cancer Program,” author Chad Schaeffer, MS, FACHE, lays the foundation for developing strategies to connect patients and the decision-making process relating to their care. Improved patient engagement can alleviate some of patients’ burden in feeling as if they are hapless victims of heinous misfortune and allow them to regain some semblance of control over their future. Schaeffer is executive director at the Edwards Comprehensive Cancer Center at Cabell Huntington Hospital, Huntington, WV.

Defining patient engagement in simple, broad terms as “the ongoing and mutually beneficial interaction between patient and providers,” he notes that putting the patients’ needs and aspirations first will improve engagement and, ultimately, satisfaction for all.

What are the goals?

Patients’ treatment goals vary and are individualistic. Some desire to extend life at any cost; others prefer quality over quantity. Many want as little disruption to their daily lives as possible. As Schaeffer points out, evening and weekend hours, though not always pleasing to cancer center staff and physicians, will allow some patients and caregivers the flexibility to carry on with their routine (work, childcare, etc.) while receiving treatment and care at a time that is convenient.

Are we meeting your needs?

Cancer center physicians often struggle with the difficult conversations regarding the “end of life,” resulting, as Schaeffer points out, in decisions that may not coincide with a patient’s wishes. According to an end-of-life study at Stanford University, family members whose loved one died in an “institutional setting” reported poor symptom management, lack of physician communication and patient engagement, and a dearth of emotional support for loved ones and caregivers. Conversely, those who passed with home hospice services reported a considerably higher degree of satisfaction with regard to unmet needs and physician engagement.

Is there something you aren’t telling me?

In addition to reviewing Press Ganey and CGCAHPS surveys, the leaders at the Bassett Cancer Institute in upstate New York have instituted a process where they can – in real time – monitor patient satisfaction. Throughout the course of their treatment, patients are offered a tablet on which they answer a few questions about their care. Questions are flagged so that when a patient expresses dissatisfaction, a member of the leadership team can address the patient’s concern during his or her visit. It gives both the patient and staff an opportunity to more effectively understand what drives patient satisfaction while giving patients an active voice in their care.

Engaging patients from the outset of their diagnosis and throughout their care is critical to their satisfaction and ultimately, as Schaeffer points out, a more effective, patient-centered cancer treatment center.

Patient–centered care is a key focus of the upcoming ACCC Annual Meeting, CANCERSCAPE, March 2-4, in Washington, D.C. Learn more here.

Read the current edition of Oncology Issues here.

ACCC member Susan van der Sommen, MHA, CMPE, FACHE, is Executive Director, DSRIP, Bassett Healthcare Network. She currently serves as chair of the ACCC Editorial Committee.