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As community cancer care providers who experience first-hand the challenges of providing quality cancer care, ACCC members are the best positioned to educate decision-makers on how coverage and reimbursement issues affect community oncology.

ACCC provides members with the information and resources needed to effectively advocate on the issues that are important to them. Together, we can positively influence the future of community oncology.

 

 

Letters to Congress

Fostering Excellence in Care and Outcomes for Patients with Stage III and IV NSCLC


November 13, 2020
Lung Cancer Graphic

Lung cancer remains the leading cause of cancer death in the United States with non-small cell lung cancer (NSCLC) accounting for the vast majority (80-85 percent) of newly diagnosed cases. Growing knowledge of NSCLC subtypes and molecular biomarkers for this disease has led to changes in how NSCLC is diagnosed and staged. This has resulted in more complexity in treatment planning and decision-making, particularly for patients diagnosed with locally advanced stage III and metastatic stage IV disease. Although more treatment options are now available to these patients, fragmentation in the U.S. healthcare system can often impede consistent access to optimal care for all patients diagnosed with locally advanced or metastatic lung cancer.

ACCC's research on effective practices in NSCLC treatment has been accepted at numerous conferences this fall. In recognition of Lung Cancer Awareness Month, here’s a look at the posters and abstracts we've recently contributed to the oncology community.

Variable Definitions of "Unresectable" Stage III NSCLC Among Lung Cancer Specialists
Poster presented at the IASCLC 2020 North America Conference on Lung Cancer October 16

Stage III NSCLC is a heterogeneous disease that often elicits differing opinions regarding what is “unresectable” depending on the specialist and treatment setting. Using survey data, we sought to characterize opinions regarding the resectability of stage III NSCLC. 

Most thoractic surgeons, medical oncologists, and pulmonologists do not consider CT or PET/CT evidence alone, or low-volume mediastinal disease to be unresectable, although a majority do consider mediastinal nodal metastases confirmed by biopsy, bulky nodal disease, or contralateral disease as unresectable. Some differences exist based on specialty and practice setting. Efforts by national organizations to standardize practice approaches and definitions of unresectability in stage III NSCLC may optimize care in this setting.

Improving Care for Patients With Stage III/IV NSCLC: Learnings for Multidisciplinary Teams at ASCO Quality Care Symposium
Abstract presented at the 2020 ASCO Quality Care Symposium October 9

Improving Care for Patients With Stage III/IV NSCLC: Learnings for Multidisciplinary Teams from the ACCC National Quality Survey 
Poster presented at the IASCLC 2020 North America Conference on Lung Cancer October 16

We designed a quality metric for ideal NSCLC care that guided the development of a national survey to improve understanding of the diagnosis and management of patients with stage III/IV NSCLC across different U.S.-based practice settings. The research lays the groundwork for designing and executing process improvement plans to address the barriers identified by the survey.

The survey provides an overview of the barriers to quality care for patients with stage III/IV NSCLC, including a lack of consistent use of multidisciplinary teams, optimized diagnosis using biomarker testing, and timely, complete staging of patients in U.S. cancer programs. Multiple opportunities exist to improve the quality and delivery of care for patients with stage III/IV NSCLC by enhancing screening, diagnosis, treatment, and care coordination for better outcomes in this patient population.

Defining High-Quality NSCLC Care at US Cancer Centers
Abstract presented at the 2020 ASCO Quality Care Symposium October 9

Rapidly evolving staging systems, diagnostic procedures, and treatment options have added complexity to existing treatment algorithms for NSCLC, and fragmentation within the U.S. healthcare system impedes consistent access to equitable care. Although multiple aspects of NSCLC management are addressed by existing guidelines, several critical features, including patient education on all aspects of NSCLC (e.g., diagnosis, staging, and treatment) and access to a multidisciplinary team care navigator for information on the financial aspects of treatment, remain unaddressed. Consequently, guidance spanning the complete care pathway is lacking.

ACCC’s initiative resulted in the development of 32 quality recommendations organized into four key care areas of the patient journey: diagnosis and biomarker testing, staging and treatment planning, care coordination and patient education, and survivorship.

Improving Non-Small Cell Lung Cancer Care Delivery: Findings for Oncology Nurses and Patient Navigators From a National Quality Survey
Abstract presented at the 2020 AONN+ Annual Conference November 6

Oncology nursing and patient navigation are vital components of optimal cancer care planning, coordination, and delivery within multidisciplinary teams (MDTs). Although widely implemented in clinical practice since its inception, the design and delivery of patient navigation services in cancer care is often heterogeneous. The role and function of patient navigation within cancer care MDTs, including evidence-based interventions that can positively impact patient outcomes, need further clarification. 

In 2019, ACCC and its partners implemented a multiphase initiative for advanced (stage III/IV) NSCLC. They found that programs with navigators for patients with NSCLC better promoted and coordinated shared decision-making (SDM) practices. However, there is a significant shortage of navigators across cancer programs to assist patients with NSCLC: 22% of respondents reported no nurse or lay navigator in their program

Improving Care for Patients With Stage III/IV NSCLC: Learnings for Thoracic Surgeons and Radiation Oncologists From a National Quality Survey
Presentation at the ASTRO 2020 Annual Meeting October 27  

Multidisciplinary teams (MDTs) could help optimize quality of care by enhancing patient involvement in decision-making, timely care delivery, accurate staging, and appropriate treatment planning. Evolving treatment modalities for stage III and IV NSCLC warrant multidisciplinary collaborations. Thoracic surgeons (TSs), radiation oncologists (ROs), and medical oncologists (MOs) as part of MDTs could play major roles in defining unresectability, diagnosis and treatment planning, and the management of patients with inoperable stage III and stage IV NSCLC.

ACCC conducted a national survey of multidisciplinary specialists, including TSs, ROs, and MOs, to obtain insights into the care of patients with advanced NSCLC across 160 U.S. community cancer programs. Mean engagement scores in shared decision-making for TSs, ROs, and MOs ranged from 3.29 to 4.73 out of 5, demonstrating occasional or frequent engagement in shared decision-making by these key specialties, suggesting opportunities for improvement.

Improving the Staging and Diagnosis of Patients With Stage III/IV Non-Small Cell Lung Cancer: Findings for Pathology and Pulmonary Medicine From a National Quality Survey
Presentation at the CAP 2020 Virtual Meeting October 10

Systematic staging and guideline-consistent biomarker testing are critical to the evaluation, treatment, and prognosis of stage III/IV NSCLC. Pathologists and pulmonologists were among the key respondents to a national quality survey that identified barriers to ideal NSCLC care delivery that could inform process improvements. The survey revealed that a significantly higher proportion of pathologists—compared to other specialists—were unfamiliar with the science behind liquid biopsy testing and tumor mutational burden.

To further the cause of improving NSCLC care, ACCC has created a suite of tools and resources:

Read More

Enhancing Oncology Model

The Centers for Medicare & Medicaid Services (CMS) has announced a new, voluntary alternative payment model, the Enhancing Oncology Model (EOM), that will allow ACCC programs to improve care coordination and health outcomes for patients, as well as deliver high-quality and affordable cancer care to the communities they serve.
Learn More

Cancer Moonshot

Read ACCC's history with the Cancer Moonshot initiative and how we plan to continue to support the White House through resources and tools on cancer prevention for underserved and marginalized patient populations.
Read More

Advocacy News Releases

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Featured Programs

The ACCC Alternative Payment Model Coalition addresses concerns about lack of preparedness to perform under Alternative Payment Models, patient and provider access to the latest treatments, infrastructure, and long-term sustainability.

The Oncology State Societies at ACCC Advocacy Engagement Pilot will establish a policy communication and learning infrastructure in nine states—Colorado, Louisiana, Missouri, New Mexico, New York, South Carolina, Texas, West Virginia, and Wisconsin—to address pressing policy issues that impact patient care and provider access. This work will focus on legislative efforts, standards of care, and health equity.

White Bagging

The Association of Community Cancer Centers and its Chapter Members from the Oncology State Societies at ACCC have developed resources for cancer care professionals to learn about the practice of white bagging, its deleterious effects on patient care, and how to take action against it.
View Resources

CMS Releases CY 2023 Medicare Payment Final Rules

On November 1, the Centers for Medicare and Medicaid Services (CMS) released the CY 2023 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) Final Rules, finalizing the agency's new reimbursement policies taking effect January 1, 2023. ACCC will host a virtual in-depth review of these final rules and their anticipated impact on oncology programs and practices as part of our 2022 Oncology Reimbursement Meetings. Register for the upcoming webinar on December 13 and view the final rules and their corresponding CMS fact sheets below:
Webinar Registration

CY 2023 Medicare Payment Resource

This member-exclusive resource provides a high-level summary of Medicare coding and reimbursement policies finalized by the Centers for Medicare and Medicaid Services (CMS) in its calendar year (CY) 2023 rulemaking cycle. Highlights include Medicare policy changes included in the CY 2023 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) final rules, including updates to the Medicare Quality Payment Program (QPP).

Download Resource (Member Login Required)

CY 2023 Medicare Proposed Rules Announced

On-Demand Webinar: The 2023 Medicare PFS and OPPS Proposed Rules: What You Need to Know

Learn about the key proposals in the CY 2023 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) proposed rules and how these proposed changes to Medicare payment will impact oncology practices, freestanding cancer centers, and hospital-based cancer programs in 2023. There will be an opportunity for live Q&A.

Speakers: 
Teri Bedard, BA, RT(R)(T), CPC
Executive Director, Client & Corporate Resources
Revenue Cycle Coding Strategies, Inc

Matt Devino, MPH
Director, Cancer Care Delivery and Health Policy
Association of Community Cancer Centers
View On-Demand Recording

 

On July 7, CMS issued the (CY) 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care—particularly in rural and underserved areas.
Read the Letter  Fact Sheet

On July 15, CMS issues the (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) proposed rule. In addition to proposing payment rates, this year’s rule includes proposals that align with several key goals of the Administration, including advancing health equity in rural areas, promoting competition in the health care system, and promoting safe, effective, and patient-centered care. The proposed rule would further the agency’s commitment to strengthening Medicare and use the lessons learned from the COVID-19 PHE to inform the approach to quality measurement.
Read the Letter  Federal Register Download

 

ACCC Principles for Drug, Diagnostics, and Biomarker Reimbursement

ACCC believes that to improve the current treatment options available for patients at the lowest cost without decreasing access to care, the following four principles should be taken into consideration.

Any proposed changes in reimbursement for drugs, diagnostics, and biomarker testing should decrease health inequities and not negatively impact the ability of cancer programs and practices to provide necessary supportive care services for potentially disadvantaged patients.
Read the Principles

Cancer Buzz Podcasts

  • Live from NOC: ACCC Priorities for the President’s Cancer Panel - [MINI PODCAST]
    Oct 10, 2023

    ACCC was invited to share the association’s key priorities for impacting cancer care in the US. ACCC president Olalekan Ajayi, PharmD, MBA, and chief operating officer at Highlands Oncology Group, PA, discusses the meeting and these initiatives.

  • Combatting Caregiver Isolation Through Awareness and Education — [MINI PODCAST] EP 130
    Aug 29, 2023

    "Many caregivers have it together, they’re on top of everything. They are organized, they are experts at this, but they are falling apart inside. You aren’t going to know if you don’t ask."

  • Pharmacy Benefit Managers: How Advocacy Led to Action [PODCAST] Ep 85
    Jun 28, 2022

    Listen to ACCC's Matt Devino and President of the Empire State Hematology & Oncology Society, Rahul Seth, DO, discuss why every voice is critical in grassroots advocacy efforts on both the federal and state level, and how cancer professionals who moonlight as patient advocates can help improve access to care and reduce financial toxicity for people living with cancer.

  • [MINI-PODCAST] Ep 79: State Advocacy Matters
    Mar 22, 2022

    Learn how state oncology societies have the power to mobilize larger groups of providers across the state to make their voices heard on behalf of their patients—and how you can get involved.   

  • [PODCAST] Ep 73: Biomarker Testing Advocacy
    Dec 7, 2021

    Biomarker testing is crucial to precision medicine, but barriers still exist. Learn from two healthcare advocates about recent policy changes designed to ensure better access to biomarker testing.

  • [MINI-PODCAST] Ep 72: Genetic Counseling Advocacy
    Nov 30, 2021

    Hear from Colleen Campbell, PhD, MS, LGC, as she explains policy changes that can help patients access genetic counseling services, while also benefiting those who provide these services. 

  • [PODCAST] Ep 56: What Comes Next for Telehealth?
    Apr 27, 2021

    We'll discuss the telehealth regulatory and policy changes enacted during the COVID-19 pandemic, what may change in 2021, and what’s likely to remain the same regarding the reimbursement of remote care. 

Fostering Excellence in Care and Outcomes for Patients with Stage III and IV NSCLC


November 13, 2020
Lung Cancer Graphic

Lung cancer remains the leading cause of cancer death in the United States with non-small cell lung cancer (NSCLC) accounting for the vast majority (80-85 percent) of newly diagnosed cases. Growing knowledge of NSCLC subtypes and molecular biomarkers for this disease has led to changes in how NSCLC is diagnosed and staged. This has resulted in more complexity in treatment planning and decision-making, particularly for patients diagnosed with locally advanced stage III and metastatic stage IV disease. Although more treatment options are now available to these patients, fragmentation in the U.S. healthcare system can often impede consistent access to optimal care for all patients diagnosed with locally advanced or metastatic lung cancer.

ACCC's research on effective practices in NSCLC treatment has been accepted at numerous conferences this fall. In recognition of Lung Cancer Awareness Month, here’s a look at the posters and abstracts we've recently contributed to the oncology community.

Variable Definitions of "Unresectable" Stage III NSCLC Among Lung Cancer Specialists
Poster presented at the IASCLC 2020 North America Conference on Lung Cancer October 16

Stage III NSCLC is a heterogeneous disease that often elicits differing opinions regarding what is “unresectable” depending on the specialist and treatment setting. Using survey data, we sought to characterize opinions regarding the resectability of stage III NSCLC. 

Most thoractic surgeons, medical oncologists, and pulmonologists do not consider CT or PET/CT evidence alone, or low-volume mediastinal disease to be unresectable, although a majority do consider mediastinal nodal metastases confirmed by biopsy, bulky nodal disease, or contralateral disease as unresectable. Some differences exist based on specialty and practice setting. Efforts by national organizations to standardize practice approaches and definitions of unresectability in stage III NSCLC may optimize care in this setting.

Improving Care for Patients With Stage III/IV NSCLC: Learnings for Multidisciplinary Teams at ASCO Quality Care Symposium
Abstract presented at the 2020 ASCO Quality Care Symposium October 9

Improving Care for Patients With Stage III/IV NSCLC: Learnings for Multidisciplinary Teams from the ACCC National Quality Survey 
Poster presented at the IASCLC 2020 North America Conference on Lung Cancer October 16

We designed a quality metric for ideal NSCLC care that guided the development of a national survey to improve understanding of the diagnosis and management of patients with stage III/IV NSCLC across different U.S.-based practice settings. The research lays the groundwork for designing and executing process improvement plans to address the barriers identified by the survey.

The survey provides an overview of the barriers to quality care for patients with stage III/IV NSCLC, including a lack of consistent use of multidisciplinary teams, optimized diagnosis using biomarker testing, and timely, complete staging of patients in U.S. cancer programs. Multiple opportunities exist to improve the quality and delivery of care for patients with stage III/IV NSCLC by enhancing screening, diagnosis, treatment, and care coordination for better outcomes in this patient population.

Defining High-Quality NSCLC Care at US Cancer Centers
Abstract presented at the 2020 ASCO Quality Care Symposium October 9

Rapidly evolving staging systems, diagnostic procedures, and treatment options have added complexity to existing treatment algorithms for NSCLC, and fragmentation within the U.S. healthcare system impedes consistent access to equitable care. Although multiple aspects of NSCLC management are addressed by existing guidelines, several critical features, including patient education on all aspects of NSCLC (e.g., diagnosis, staging, and treatment) and access to a multidisciplinary team care navigator for information on the financial aspects of treatment, remain unaddressed. Consequently, guidance spanning the complete care pathway is lacking.

ACCC’s initiative resulted in the development of 32 quality recommendations organized into four key care areas of the patient journey: diagnosis and biomarker testing, staging and treatment planning, care coordination and patient education, and survivorship.

Improving Non-Small Cell Lung Cancer Care Delivery: Findings for Oncology Nurses and Patient Navigators From a National Quality Survey
Abstract presented at the 2020 AONN+ Annual Conference November 6

Oncology nursing and patient navigation are vital components of optimal cancer care planning, coordination, and delivery within multidisciplinary teams (MDTs). Although widely implemented in clinical practice since its inception, the design and delivery of patient navigation services in cancer care is often heterogeneous. The role and function of patient navigation within cancer care MDTs, including evidence-based interventions that can positively impact patient outcomes, need further clarification. 

In 2019, ACCC and its partners implemented a multiphase initiative for advanced (stage III/IV) NSCLC. They found that programs with navigators for patients with NSCLC better promoted and coordinated shared decision-making (SDM) practices. However, there is a significant shortage of navigators across cancer programs to assist patients with NSCLC: 22% of respondents reported no nurse or lay navigator in their program

Improving Care for Patients With Stage III/IV NSCLC: Learnings for Thoracic Surgeons and Radiation Oncologists From a National Quality Survey
Presentation at the ASTRO 2020 Annual Meeting October 27  

Multidisciplinary teams (MDTs) could help optimize quality of care by enhancing patient involvement in decision-making, timely care delivery, accurate staging, and appropriate treatment planning. Evolving treatment modalities for stage III and IV NSCLC warrant multidisciplinary collaborations. Thoracic surgeons (TSs), radiation oncologists (ROs), and medical oncologists (MOs) as part of MDTs could play major roles in defining unresectability, diagnosis and treatment planning, and the management of patients with inoperable stage III and stage IV NSCLC.

ACCC conducted a national survey of multidisciplinary specialists, including TSs, ROs, and MOs, to obtain insights into the care of patients with advanced NSCLC across 160 U.S. community cancer programs. Mean engagement scores in shared decision-making for TSs, ROs, and MOs ranged from 3.29 to 4.73 out of 5, demonstrating occasional or frequent engagement in shared decision-making by these key specialties, suggesting opportunities for improvement.

Improving the Staging and Diagnosis of Patients With Stage III/IV Non-Small Cell Lung Cancer: Findings for Pathology and Pulmonary Medicine From a National Quality Survey
Presentation at the CAP 2020 Virtual Meeting October 10

Systematic staging and guideline-consistent biomarker testing are critical to the evaluation, treatment, and prognosis of stage III/IV NSCLC. Pathologists and pulmonologists were among the key respondents to a national quality survey that identified barriers to ideal NSCLC care delivery that could inform process improvements. The survey revealed that a significantly higher proportion of pathologists—compared to other specialists—were unfamiliar with the science behind liquid biopsy testing and tumor mutational burden.

To further the cause of improving NSCLC care, ACCC has created a suite of tools and resources:

Read More