2016 ACCC Trends Survey-Physicians Question Title * 1. Name: Question Title * 2. Title: Question Title * 3. Organization: Question Title * 4. Phone: Question Title * 5. Email: Question Title * 6. What is your program doing to help reduce costs? (CHECK ALL THAT APPLY) Partnering with PCPs to provide integrated and more cost effective services to the community. Partnering with community providers to deliver care, such as mammograms, outside of the hospital setting. Exploring ways to partner with PCPs to provide survivorship care. Embedded a primary care provider within the cancer program. Developed best practices related to cost containment, such as use of lower-cost medications as appropriate. Create order sets to utilize most cost effective supportive drugs (e.g. anti-emetics) Adopt guidelines and/or pathways Monitor compliance Tracking the frequency and use of high-cost medications. Development of cancer drug formulary in-house. Require physicians to meet specific quality and cost management goals. Working with physicians to reduce unnecessary hospitalizations. Partnering with clinics in rural locations so patients can have labs done prior to treatment appointments. Established a high-risk clinic with a goal of preventing cancer and reducing hospitalizations. Development of cancer urgent care services. Monitor advanced and high-risk patients in efforts to reduce unnecessary ER visits and hospitalizations. Engaged in any LEAN initiatives, such as streamlining processes, improving quality of care, and improving revenue stream. Eliminating duplication of services through automated reminders generated by EHR and/or patient portal. Affiliating with a multi-specialty practice to eliminate duplication of services. Planning to move cancer-related services to one location to take advantage of economies of scale. Adding services to reduce cost of care, including oncology rehabilitation, nurse call centers for symptom management, and nurse practitioner-based survivorship care. Providing advanced care planning and/or end-of-life discussions early in treatment. Other (please specify) Question Title * 7. How is your cancer program impacted by new care delivery models? (CHECK ALL THAT APPLY) Applied to be a part of the Oncology Care Model (OCM). Selected to be part of the Oncology Care Model ()CM) Participating in an accountable care organization (ACO). Participating in an oncology medical home (OMH). Working with payers to develop a new care delivery model. Developing a pay-for-performance model. Reviewing ways to bundle services in anticipation for CMS bundling services. Developing a population-based health model at our hospital. Developed and following clinical treatment pathways to standardize care. Partnering with an academic program to provide specialized care and to ensure seamless transition of patients between care settings. Participating in an alliance of cancer programs to offer clinical trials. Partnering with PCPs on outreach, screening, and prevention efforts. Working with PCPs to streamline referral process. Developed a hospital-employed physician referral basis. Other (please specify) Question Title * 8. 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. We use translation software to ensure patients can participate in shared decision-making. Other (please specify) Question Title * 9. 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. Chemo ordering. 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). Ability to provide cost estimates prior to treatment (chemotherapy, radiation, surgery, imaging). Other (please specify) Question Title * 10. How does your program conduct shared decision-making between physicians, cancer program staff, and patients? (CHECK ALL THAT APPLY) Patients and caregivers can participate in tumor boards. Primary care physicians (PCPs) are asked to participate in tumor boards. Treatment recommendations from multidisciplinary meetings are shared with patients and caregivers by the physician. Treatment recommendations from multidisciplinary meetings are shared with patients and caregivers by the advanced nurse practitioner. Treatment recommendations from multidisciplinary meetings are shared with patients and caregivers by the nurse navigator. Treatment recommendations from multidisciplinary meetings are shared with PCPs by the physician. Treatment recommendations from multidisciplinary meetings are shared with PCPs by the advanced nurse practitioner. Treatment recommendations from multidisciplinary meetings are shared with PCPs by the nurse navigator. Communication tools are used to ensure treatment options and outcomes are clearly communicated with patients and caregivers. Clinical trials are identified and shared with patients when relevant. Training staff in formal shared decision making. Educating patients in shared decision making and that they have choices. Shared decision making required, documented and tracked. Other (please specify) Question Title * 11. What staff member(s) are responsible for cost of care discussions? (CHECK ALL THAT APPLY) Physicians Advanced nurse practitioners Nurse navigators Oncology social workers Pharmacists Financial advocates Billing and collections staff Other (please specify) Question Title * 12. From a physician perspective, how do you feel about having financial discussions with patients? (CHECK ALL THAT APPLY) I am very comfortable having financial and cost of care discussions with patients. I am somewhat comfortable having financial and cost of care discussions with patients. I am somewhat uncomfortable having financial and cost of care discussions with patients. I am very uncomfortable having financial and cost of care discussions with patients. Other (please specify) Question Title * 13. At your program, these financial discussions with patients are delivered by: (CHECK ALL THAT APPLY) Physicians Mid-level practitioners Oncology nurses Nurse navigators Oncology social workers Financial advocates Billing and collections staff Other (please specify) Question Title * 14. Which of the following statements most accurately reflects your belief? (CHECK ONLY ONE) Cost of care is an important part of shared decision making. Cost of care should be taken into account when making treatment decisions. Cost of care should NOT be taken into account when making treatment decisions. Cost of care should be shared with patients prior to making treatment decisions. Question Title * 15. What financial assistance do you offer patients? (CHECK ALL THAT APPLY) 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. Financial counselors do risk assessment and meet proactively with HIGH-RISK patients Our financial advocates meet with ALL patients to discuss co-pay programs and patient responsibilities. Financial counselors do not meet with patients until financial difficulties are identified 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 * 16. 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 * 17. 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 * 18. How knowledgeable are you about biosimilars (CHECK ONLY ONE) Very familiar Familiar Somewhat familiar Not familiar Question Title * 19. What are the major challenges and/or barriers your cancer program faces when implementing targeted therapies? (CHECK ALL THAT APPLY) Complex and burdensome testing processes The high cost of targeted therapies Inadequate reimbursement for targeted therapies Ensuring that staff is educated and up-to-date on the latest targeted therapies The time that is needed to educate patients and caregivers about targeted therapies The time that is needed to screen patients for eligibility. Tissue acquisition. EHR incompatibility. Communication between different disciplines Delays for ordering and/or receiving test results to determine therapy Need for additional training for the multidisciplinary team Other (please specify) Question Title * 20. 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 * 21. 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 * 22. 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. Discontinuation of bundling of services. The need for policymakers 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. Societal expectations for value of care Societal expectations for access to care I see no value to these conversations. Other (please specify) Done
