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Speaker Reflections: Attending ACCC’s Oncology Reimbursement Meetings

By Wendi Waugh, RT(R)(T), CMD, CTR

May 27, 2022
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I had the distinct pleasure of attending and presenting at the ACCC Oncology Reimbursement Meetings (ORMs) in San Diego, Calif., and Denver, Colo., earlier this month. Upon reflecting on the content that was presented and interactions I experienced at these meetings, I had some thoughts worth documenting. 

The Multidisciplinary Care Team

First, I think it is important to understand the perspective of the intended ORM audience. These meetings were created by ACCC to help its member programs and practices keep up to date on topics and issues impacting oncology reimbursement (e.g., payer policies, Medicare/Medicaid rules, financial advocacy, revenue cycle management, billing & coding, etc.).

I am a director at a hospital-based cancer center in southern Ohio. As an administrative director, I suspect that the financial perspective I bring to the table, when listening and interacting with other members of the multidisciplinary cancer care team, may be slightly different than the perspectives of those who work at pharmaceutical companies or the financial advocates, practice managers, pharmacists, or drug reimbursement specialists at a cancer center. With my administrator hat on, I was impressed by the extensive knowledge that was presented by our speakers at these meetings and that is required of those whose role relates to reimbursement. Financial advocates, prior authorization teams, and billing staff all possess a unique and wide range of knowledge and talent. And any gap in this team or individual role (depending on a cancer program or practice’s size and complexity) potentially creates financial risk. As a result of my participation in the ORMs, I gained a sincere appreciation for the criticality of these various roles and the importance of ensuring that cancer program leadership have the right people in these key positions. 

Formulary Management & Reimbursement

Secondly, you cannot attend an oncology reimbursement meeting today without discussing white bagging. The processes involved in obtaining medication through white bagging—a payer requirement that certain drugs be shipped from a third-party specialty pharmacy directly to a provider’s office for administration—is daunting. As oncology professionals, we must educate insurers and policy makers not only about the burdens white bagging places on pharmacy staff, financial advocates, scheduling staff, and other healthcare professionals but also the risks associated with this practice—from patient safety (treatment delays and delivery errors) to financial concerns (there’s heavy process coordination compared to the traditional buy-and-bill model, yet it only yields a fraction of the reimbursement). 

Conversations led by our speakers did not end at white bagging, as we moved to the ever-popular topic of biosimilars. I learned from Dr. Zinkeng Asonganyi, director of Pharmacy Services-Ambulatory Operations at the University of Texas Medical Branch, that some cancer centers have established policies on when and how oncology staff can swap a prescribed medication to a biosimilar product. I also learned the difference between a biosimilar, its reference product, and a generic substitution; they are not the same. This leads me to ask one question: Would your cancer center initiate a switch to a biosimilar for a patient mid-treatment if their payer mandated it, or would your clinician take the time to conduct a peer-to-peer to try to keep the patient on the original treatment as prescribed?  For those who would defend the need for the initial prescription to the payer, would you also defend this choice among your internal Pharmacy and Therapeutics Committee if a biosimilar was recently added to your formulary? Regardless of your answer, it was refreshing for me to consider and debate these relevant topics among colleagues and experts once again. 

Networking and Learning Together

Lastly, oncology programs and practices face the ongoing challenge of staffing, from developing the right sizing of your departments to ensuring coverage of the wide-ranging complexities in oncology. Staffing challenges extend beyond the woes of not having enough staff on-site or a lop-sided skill mix. At the recent ORMs, attendees, speakers, and industry had the opportunity to listen to and network with one another, while also discussing current staffing structures and new onboarding/orientation processes. It seems that the days of assigning new staff to experienced individuals for shadowing and onboarding have dissipated beneath our feet. Through conversations, I learned that many cancer centers are left with limited guidance and resources to help their new staff be successful. If leadership are lucky enough to attract the unique talents they need, retaining this talent is a much different dynamic in this ever-changing competitive job market that has only been exacerbated by the COVID-19 pandemic.

Fortunately for us, these ORMs served as a hub for cross-functional sharing and brainstorming among colleagues, which I found to be refreshing and much-needed after a long stent of non-existent face-to-face discussions. The wide range of speakers and attendees provided just the right mix of formal and informal dialogue to garner great tips and tricks to bring back to my cancer center, while also sharing some of my own. It was so uplifting to see ACCC provide recently-created tools and forums for attendees to use when addressing these issues, including the digital Patient Assistance & Reimbursement Guide and Financial Advocacy Playbook. And for those unable to travel or who prefer virtual content, ACCC’s recent live broadcast from the Alternative Payment Model Coalition—Navigating the Great Resignation: Rebuilding the Healthcare Labor Force and the Challenges Ahead—is valuable just the same.

Attend the third ORM this spring in Greensboro, N.C., on Tuesday, June 21, 2022.

Wendi Waugh, RT(R)(T), CMD, CTR, Administrative Director of Cancer Services & Ambulatory Infusion at Southern Ohio Medical Center, Southern Ohio Medical Center Cancer Center in Portsmouth, Ohio. She is also an ACCC Board Member and Financial Advocacy Network Advisory Committee Member.

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