2016 ACCC Trends Survey-Nurses Question Title * 1. Name: Question Title * 2. Title: Question Title * 3. Organization: Question Title * 4. Phone: Question Title * 5. Email: Question Title * 6. What resources and benchmarks do you use to develop your nurse staffing model? (CHECK ALL THAT APPLY) We have developed our own nurse staffing model based on a patient acuity scale. We have adapted an existing nurse staffing model based on a patient acuity scale. We use resources and benchmark data developed by the Association of Community Cancer Centers (ACCC). We use resources and benchmark data developed by the Oncology Nursing Society (ONS). We use resources and benchmark data developed by the Advisory Board Company’s Oncology Roundtable. We use resources and benchmark data developed by the Medical Group Management Association (MGMA). Other (please specify) Question Title * 7. Has your cancer program added staff and/or services to meet demand for patient-centered care? (CHECK ALL THAT APPLY) We have added financial advocate(s). We have added lay navigator(s). We have added nurse navigator(s). We have added social worker(s). We have added dietitian(s). We had added palliative care professionals(s). We have added community health specialist(s). We have added physician liaison(s). We have established a survivorship clinic. We have established a nutrition clinic. We have established a lung cancer screening clinic. We have established a symptom management clinic. We have established a call center where patients can reach providers, 7 days a week, 24 hours a day. We have opened our infusion center to offer services outside of chemotherapy with expanded coverage, 7 days a week, 12 hours a day. We have not added staff or services in the last 12 months. Other (please specify) Question Title * 8. How do you fund non-reimbursable positions? positions (e.g., dietitians, financial advocates, patient navigators)? (CHECK ALL THAT APPLY) We track cases per FTE to measure costs and ROI on non-reimbursable positions. We incur the cost of non-reimbursable positions that support accreditation efforts. We incur the costs of non-reimbursable positions to ensure quality, patient-centered care. We incur the costs of non-reimbursable positions, such as patient navigators, because use of these professionals improves patient and physician satisfaction. We incur the costs of non-reimbursable positions that support programs and/or services related to our community health needs assessment. We incur the costs of non-reimbursable positions by sharing data that show these professionals can help reduce hospitalizations and ER visits. We incur the cost of non-reimbursable positions that help achieve population health goals. We fund non-reimbursable positions through community donations or philanthropy. We fund non-reimbursable positions through grants. We fund non-reimbursable positions through the hospital’s charitable foundation. We fund our financial advocate positions through savings in charity write-offs and bad debt. We fund our social work positions by sharing data that show social workers can have a positive impact to the bottom line by helping patients get to their appointments and stay on treatment. We fund non-reimbursable positions out of revenue generated from medical and radiation oncology. We are exploring the possibility of charging for social work and dietitian services. Other (please specify) Question Title * 9. How is staff educated on new treatments and technology, such as immunotherapy? (CHECK ALL THAT APPLY) We host physician and staff Lunch & Learns. We have an internal professional education and development program. We partner with an academic program to provide CME and CEU opportunities. We offer education opportunities through our School of Medicine. We have a telehealth professional education program with academic partner. Our pharmacy educates staff about new products and therapies. Our oncologists host monthly education sessions for staff, including updates to available clinical trials. We host disease-site specific conferences, including screening, diagnostics, and treatment. We host discipline-specific education conferences. We host an annual ASCO Review Meeting to present the most relevant scientific data. We use our treatment planning conferences to educate staff on new technology and treatments. We have made it mandatory for staff to attend Grand Rounds. We have made it mandatory for staff to attend tumor boards. We educate PCPs using focused mailings on specific types of cancer. Our hospital nurse educator develops education opportunities onsite. Our staff utilizes online education modules and educational webinars. We utilize web-based subject matter specialists vetted by our educators. We allow drug reps to provide informal lunches and formal dinner presentations. We allow drug reps to provide education in the infusion area. Our oncology-certified pharmacist acts as “gatekeeper” for industry-sponsored education. We do not allow drug reps access to our cancer program. We receive education from professional organizations, such as ONS, ASCO, ACCC, AOSW, etc. We disseminate white papers and clinical and programmatic journals to staff. ACCC resources, including journal, e-newsletters, and meetings. We participate in Institute for Clinical Immuno-Oncology (ICLIO) educational opportunities (e.g., webinars, meetings, newsletters) We receive education through our membership to the Oncology Roundtable. Other (please specify) Question Title * 10. How does your cancer program fund staff education? (CHECK ALL THAT APPLY) We carve out CME time for all providers and staff. We use philanthropy to pay for staff to attend educational conferences. We reimburse staff for certification expenses. We offer bonuses for certification and re-certification. Providers have a CE budget for travel to meetings or self-learning. We budget for specialties to include a national conference annually. Other (please specify) Question Title * 11. How does your cancer program address disparities and/or access to care issues? (CHECK ALL THAT APPLY) We use patient navigators to help navigate underserved patients through our healthcare system. We partner with community organizations in outreach efforts to underserved populations. We have initiated quality improvement projects to improve services to specific patient populations (i.e., African-American, Asian, Native American). We use translators or translation software to ensure patients can participate in shared decision-making. We offer education and resources to patients and caregivers to help improve their health literacy. We offer telehealth services for patients in rural locations. We have opened satellite locations so that patients can receive care in their own communities. We have a transportation program in place to ensure patients can get to their treatment visits. We partner with an organization to provide transportation for patients. Other (please specify) Question Title * 12. How does your cancer program ensure patient access to clinical trials? (CHECK ALL THAT APPLY) We have developed a process to screen all patients for eligibility in open clinical trials. We provide staff education about clinical trials for which we are currently accruing patients. We have developed a tool that helps staff stay current with clinical trials that are accruing patients. Our physicians take the lead in identifying patients eligible for open clinical trials. Our clinical research nurses take the lead in identifying patients eligible for open clinical trials. Our nurse navigators take the lead in identifying patients eligible for open clinical trials. We discuss clinical trial participation at our multidisciplinary tumor boards. Our research staff works with cancer registry and members of the cancer care team to identify patients that may benefit from clinical trial participation. We have information about clinical trials available to patients in our waiting and exam rooms. We direct patients to our website for information about available clinical trials. Other (please specify) Question Title * 13. What financial advocacy services do you offer patients? (CHECK ALL THAT APPLY) We use a screening tool to identify patients in need. We employ financial advocates (counselors). We use social workers to provide some financial assistance services. We have a philanthropic foundation that offers patient assistance. We use pharmaceutical drug replacement program(s) that provide “free” drugs for the indigent or those unable to afford medications. Our financial advocates meet with all new patients to discuss insurance options and cost of care. Our financial advocates provide all patients with estimates of care costs. Our financial advocates meet with all patients to discuss co-pay programs and patient responsibilities. We provide assistance with transportation costs and gas cards. We have pharmacy and financial counselors available but they are managed outside of the cancer program. We have a formal preauthorization and cost estimate program. Our pharmacy revenue team oversees patient assistant programs, op-pay and deductible assistance, foundation applications, and urgent needs fund. Other (please specify) Question Title * 14. How do you measure the value and/or impact of your financial advocacy services? (CHECK ALL THAT APPLY) We track the number of patients our financial advocacy team assists annually. We track the utilization of philanthropic funds annually. We track the dollar value of free drugs provided annually. We track the dollar value of the co-pay cards provided annually. We track bad debt and charity write-off. Other (please specify) Question Title * 15. What type of support does your cancer program offer for patients on oral oncolytics? (CHECK ALL THAT APPLY) A financial advocate meets with all patients who are prescribed an oral oncolytic. A nurse provides education on the oral chemotherapy medication, including safe handling procedures, the important of adherence, and how to identify, manage, and report side effects. A pharmacist or pharmacy technician provides education on the oral chemotherapy medication, including safe handling procedures, the importance of adherence and how to identify, manage, and report side effects. We provide patients with printed education materials about the oral medication, safe handling procedures, and the importance of patient adherence. Our patients on oral medications have access to a 24-hour phone number to call with questions or problems. We provide patients with tools, such as pill boxes, personalized calendars, diaries, dosing cards, and/or alarms to help ensure adherence. We ask patients to bring medication bottles to each visit so that cancer program staff can do a pill count. We track when a prescription for an oral medication is first filled. We track refills of oral medications. We use a checklist to identify areas where patients may require additional education. Other (please specify) Question Title * 16. How is your cancer program employing technology to remove barriers to care? (CHECK ALL THAT APPLY) PCPs and referring physicians participate in treatment planning conferences via teleconference. Videoconferences with our academic partner program as needed. Virtual tumor boards with an academic partner program. Virtual tumor boards with providers and hospitals in our community. Virtual tumor boards with 3rd party laboratories. Videoconferencing capabilities so that physicians from multiple locations can participate in tumor boards. A telegenetics program. We use telemedicine technology to reduce unnecessary office visits. We are exploring virtual patient visits. Patient portal. Oral chemotherapy monitoring tool sent to patients and returned back to pharmacy via the patient portal. We have a patient portal, but our providers and patients have been slow to adopt use. Tablet-based tool for patient assessments and screenings. Kiosks in each clinic that patients can use to streamline check-in and other processes. Implemented physician scheduling via mobile devices. Researching ways to have patients complete information remotely and send to cancer program ahead of appointment. Other (please specify) Question Title * 17. What are your cancer program’s biggest IT challenges? (CHECK ALL THAT APPLY) Funding IT hardware, software, and personnel. Getting different EHRs to talk to each other and integrate data. EHR not oncology-specific Patients who do not have the resources to participate in our patient portal. Hardware and software costs for telemedicine and virtual tumor boards; when one program updates all other programs must also update to remain compatible. Prior authorizations remain labor and time intensive. Accessing data necessary to monitor quality metrics, support market share analysis, and meet increasing regulatory and certification requirements. Having fields/tabs to capture, pull and share relevant data" (e.g., molecular testing status/results). EMR upgrades and staff/physicians training. Cost to build an interface. Providing data extraction/migration to systems other than our own. Other (please specify) Question Title * 18. What challenges or concerns would you share with your Congressional representative? (CHECK ALL THAT APPLY) Ways to eliminate ineffective care as an option to cutting reimbursement for useful and life-saving services. Parameters or ceilings for new chemotherapy and immunotherapy drugs. How manufacturer restrictions for oral oncolytics, such as specialty pharmacies and narrow distribution channels, have had a negative impact on my ability to provide safe, quality patient care. Regulation of vial size to reduce or eliminate drug waste as is required in European countries. Transparency in commercial insurance policies so patients know exactly what plans do (and do not) cover. Reducing the “standards” that must be met as they are time and resource intensive for programs already challenged by reimbursement cuts. The cost of cancer drugs remains a big concern for patients and providers. Increased funding for cancer research and clinical trials. Increased funding for underserved populations. Reimbursement of non-revenue producing services that improve patient care (i.e., navigation, survivorship, financial advocacy). Federal oral parity legislation. Concerns about the Medicare Part B pilot. The importance of the 340B drug pricing program. Discontinuation of bundling of services. The need for policymakers to talk to the soldiers in the trenches to define quality. The creation of true measures that reflect quality care. A process for cancer programs to monitor other programs to ensure standards of care are met and efficiencies shared. The need to streamline coding, billing, and payment requirements. The removal of prior authorizations for all diagnostic tests and procedures. The need for physicians and mid-level providers to focus on direct patient care—not paperwork. Medicare Part D to pay for vaccinations given at a cancer program. I see no value to these conversations. Other (please specify) Done
