Approximately 200 individuals attended a general session during the annual meeting of the Commission on Cancer (CoC), May 16–17, at the American College of Surgeons (ACS) headquarters in Chicago, IL. Daniel P. McKellar, MD, FACS, CoC Chair, clinical professor of surgery at Wright State University, Dayton, OH, and director of the cancer program at Wayne HealthCare, Greenville, OH, presided over the session, which focused on advances in care for oncology patients.
Patient-centered medical home
In a keynote address, John D. Sprandio, MD, described the oncology patient-centered medical home (OPCMH) model that he pioneered at Oncology Management Services, Drexel, PA. Dr. Sprandio is the chief of medical oncology and hematology and chief physician at the institution, and told the gathering that the OPCMH has enhanced quality of care and reduced costs.
Each year, Dr. Sprandio said, some 1.6 million Americans receive a cancer diagnosis, and they enter a health care environment that is expensive and fragmented. Health care’s basic equation, Dr. Sprandio said, is that the value of care equals quality divided by cost. Quality of care improves when the reliability of health care services increases, and therefore, this equation turns the focus to consistent and reliable care, with costs controlled by reducing waste. Waste in health care occurs when physicians fail to deliver and coordinate patient care, which, in turn, leads to fragmentation and overtreatment, he noted.
In 2012, U.S. health care came at a cost of $2.8 trillion, which, taken alone, would represent the world’s fifth largest economy, Dr. Sprandio said. The U.S. pays a high price for health care and outspends the rest of the industrial world by 141 percent.* Ultimately, the high cost of health care is driven by deficiencies in delivery of services, coordination of care, overuse of resources, pricing, administrative burden, and fraud. Physicians, he noted, have control only over the first three factors: delivery, coordination of care, and overuse of resources.
These shortcomings, which lead to duplication of services, are attributable in part to low adherence to clinical guidelines and cause the patient population not only to face unnecessary delays in treatment, but also to assume a secondary role in their own care.
Using evidence-based platforms, including the National Committee for Quality Assurance’s patient-centered medical home model, Dr. Sprandio and other clinicians at his institution reengineered the model to address issues of quality and cost and matters of practice accountability for all cancer care, standardized patient evaluations, multidisciplinary care plans, the support of patient navigators, and ongoing performance reviews.
“The process of improving the delivery of cancer care and reducing unnecessary use are intertwined. They are one and the same,” he said. “If improving care is the plan, then physicians own the plan,” he said. “Government can’t do it. Payors can’t do it. Regulations can’t do it. Only the people who give the care can improve the care.”
Dr. Sprandio asserted that the patient-centered medical home model defines the measurement of care and ultimately responds to patients’ needs, and noted improvements in clinical measures that the OPCMH model has produced:
- Emergency department visits by chemotherapy patients per year declined by 65 percent
- The number of patients admitted to the hospital dropped by 45 percent over a five-year period
- Length of stay for patients admitted declined by 21 percent
The model, he said, transforms the delivery of cancer care within the practice without the need for a costly third-party vendor.
Updates on CoC activities
The general session also featured updates on current CoC-related activities and programs.
Heidi Nelson, MD, FACS, Rochester, MN, Program Director of the ACS Clinical Research Program within the Alliance for Clinical Trials in Oncology, noted the group’s ongoing work to seek out new ways to connect diverse types of research efforts. “Our work is to take basic science and turn it into cancer treatment,” Dr. Nelson said.
The CoC Accreditation Committee, represented by Chair Linda W. Ferris, PhD, vice-president, oncology system service line, Centura Health, Denver, CO, continues to create new accreditation products and enhance the best practices repository. The Accreditation Committee also has identified potential new surveyors and begun to revamp the orientation these individuals receive. A patient Web portal for cancer survivors to collect information on the survivorship experience was discussed and approved for further evaluation.
Reporting on the work of the Quality Integration Committee, Chair Christopher M. Pezzi, MD, FACS, senior surgeon, director of surgical oncology, and associate program director for general surgery residence at Abington (PA) Memorial Hospital, and clinical associate professor, Drexel University College of Medicine, Philadelphia, described the expansion of quality measures that define cancer care. Part of the committee’s work is to promote the quality, breadth, and timeliness of the data provided for entry into the National Cancer Data Base (NCDB).
Speaking on behalf of the CoC-member Organization Steering Committee, Chair Virginia Vaitones, MSE, OSW-C, Rockport, ME, noted efforts to raise awareness of the CoC mission, including use of the Commission’s logo, and to support the work of the Advocacy Subcommittee. Ms. Vaitones spoke of One Voice Against Cancer Lobby Day, which took place this year in July.
Ms. Vaitones also presented the results of a 2013 survey that was sent to the executive directors of all member organizations. Among other findings, the study showed that the most prevalent reason that members stay involved in the CoC is the benefits of participation in CoC programs and initiatives. Executive directors who responded to the survey indicated that the CoC’s most vital responsibility is to work collaboratively with other member organizations, to promote the organization to CoC members, and to provide the membership with regular CoC updates.
Howard Kaufman, MD, FACS, Rush University Medical Center, Chicago, and Chair of the CoC Education Committee, noted that a number of webinars are available for educating CoC members on the newly launched ACS Cancer Programs Online Education Portal. The new portal allows CoC-accredited cancer program staff complimentary access to CoC webinars. The committee is actively seeking nominations for the 2014 Clinical Congress Oncology Lecturer among other activities.
Committee on Cancer Liaison Chair Phillip Y. Roland, MD, FACS, gynecologic oncologist, St. Francis Hospital and Medical Center, Hartford, CT, presented a report on activities of the volunteer State and Regional Chairs. The Cancer Liaison Physician’s (CLP) role has evolved, he said, from participation in performance monitoring to improving the quality of cancer care and shaping cancer leaders. The state chairs, he noted, also collaborate with the American Cancer Society and use NCDB data to monitor quality of care. In a recent survey, the committee learned that 87 percent of CLPs use NCDB data to monitor the quality of care and that 41 percent of the CLPs are involved in advocating for state legislation.
Former CoC Chair Stephen Edge, MD, FACS, the Alfieri Family Charitable Foundation Endowed Chair in Breast Oncology and medical director of the Breast Center at Roswell Park Cancer Institute in Buffalo, NY, and Chair of the CoC Nominating Committee, described a new process for nominating members to the CoC as ACS representatives. The CoC, he said, increasingly requires specific expertise and experience, and the current system does not identify all of the individuals who might contribute significantly to the work of the Commission.
“It’s very exciting to see the work of the Commission,” Dr. Edge said. “It’s easy to forget that this is a volunteer organization.”
Need for advocacy
The enemy of quality cancer care, Dr. McKellar concluded, includes the 2 percent sequestration cuts, which the U.S. Congress imposed on March 1, and the out-of-pocket expenses required for cancer patients.
“We are in a nasty transition period,” Dr. McKellar said. “Hospitals under the most duress may have to stop accepting Medicare patients.”
Does the CoC have the ability to respond to external events such as these? asked a member of the audience. “No, we do not,” responded Dr. McKellar. “That’s why the CoC needs to increase its advocacy efforts nationally.”
*Thompson D. OECD: U.S. Outspends Average Developed Country 141% in Health Care, Atlantic Monthly. April 12, 2011. Available at www.theatlantic.com/business/archive/2011/04/oecd-us-outspends-average-developed-country-141-in-health-care/237171/. Accessed May 22, 2013.