Cancer Registry Poised to Support Accountable Care Reimbursement & Strengthen the Bottom Line

Focus on quality of care and quality of data leads innovative organizations and fiscally focused executives to increasingly turn to the cancer registry

Introduction: Accountable Care, the Bottom Line and the Cancer Registry

Recently profiled in the April 23, 2013 New York Times article, “A Health Provider Strives to Keep Hospital Beds Empty,” Advocate Health Care has embraced accountable care and has already achieved a two percent cost savings as a direct result. According to the article, thus far, hospital admissions are down six percent, and days spent in the hospital are down nearly nine percent. To facilitate the change, “Advocate has hired scores of workers to coordinate care and keep an eye on the highest-cost patients...”

According to the same NY Times article, an estimated 428 accountable-care organizations now cover four million Medicare enrollees and millions more people with private insurance.

While many pundits believe the accountable care movement could be the most meaningful recent development in the effort to fix our nation’s health care industry, hospital executives are only beginning to open their eyes to the powerful role their cancer registries can play in the quest for profitability during and beyond the transition. Critically important, the quality of data collection directly affects patient outcomes and reimbursement, and executives should take a few simple steps today to assess the quality of their cancer registry data, begin to use it more effectively and improve future financial performance.

Data quality’s impact on patient care, outcomes and the bottom line

Suspect data affects patient outcomes, and in accountable care organizations this also harms financial performance. Accountable care organizations link payments to quality improvements and cost reductions, a practice that will spread to cancer care soon. The deeper hospitals move into pay for performance, the more data their executives will need to prove quality of care.

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Executives should take the time to examine the sources of their organizations’ data and how they acquire and report that data. Turning to the best data sources can boost reimbursement and financial performance of cancer centers and their parent organizations, and the best source for data related to cancer is undoubtedly the cancer registry department.

Cancer registries already maintain the highest quality data

Throughout the industry, the many ways organizations have begun to harness cancer registry data speaks to their confidence in the quality of that data. At some of the hospitals and health networks that work with Care Communications to ensure efficiency and effectiveness in cancer registry departments, cancer registry data has been effectively put to use in many different ways. Already, organizations use cancer registry data to justify new investments in technology or medical expertise. Many use the data to grade their own cancer center’s performance against benchmarks, determine if patients receive appropriate treatment, and educate physicians on what standards of care should be. In other instances, organizations use the data to analyze referral patterns or better understand their customer base. As more organizations begin to understand the value of this data as a competitive advantage for critical analysis and decision making, the industry’s growing confidence in the quality of data from the cancer registry will most likely only continue to rise. This makes perfect sense, considering the origin of that data.

Abstracted by trained professionals, the cancer registry is a reliable, yet under-utilized source of cancer outcomes data. To ensure data quality standards, cancer registries remain highly regulated but offer the flexibility to be easily expanded in an organization’s efforts to collect additional helpful information and data that can further enhance patient care or the organization’s bottom line.

the heightened quality of data housed in cancer registries can deliver a positive impact on efforts to reduce costs and improve reimbursement.

The cancer registry should already be positioned to help the organization, because it can efficiently provide all required outcomes data. Unfortunately, many organizations mistakenly overlook the cancer registry as a quality data source and waste extensive time and resources by recreating much of the same data.

Beyond outcomes data, the cancer registry can be used to determine outbound and inbound patient referrals, which can provide an accurate assessment of both lost and realized opportunity. For example, if the organization has referred numerous patients to a nearby breast surgeon for appropriate treatment, then perhaps the organization should consider hiring a breast surgeon. This could help ensure that the patient can receive treatment with the organization managing their care. Similarly, if the cancer registry data shows numerous inbound referrals for specific treatments, there may be an opportunity to expand this part of the organization to ensure effective, timely treatment for patients.

By taking simple steps today, including asking a few simple questions to assess the current state of the cancer registry, the already impressive quality of cancer registry data can be further improved, along with its impact on tomorrow’s bottom line.

Cancer registry now the definitive source for cancer outcomes data

The cancer registry exists as the timeliest, most complete and most accurate data source for most accredited cancer programs and should be every executive’s preferred source for all cancer-related outcomes data. Revised in 2012, the ACoS CoC standards shifted the focus of the standards to the quality of patient care and enhanced the reporting of cancer data to include concurrent abstracting options with the introduction of the Rapid Quality Reporting Systemii i (RQRS).

Cancer registries... (cont’d)

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Turning to the cancer registry as a trusted source for data ensures quality, thanks to the American College of Surgeons (ACoS) Commission on Cancer (CoC) and its stringent regulations on data quality. Its published standards for data quality i require all case abstracting to be performed by a Certified Tumor Registrar (CTR) in a timely manner (90 percent of cases are abstracted within six months of the date of first contact with the program). The standards also present mandated follow-up rates of 80 percent for all patients and 90 percent for recent patients, as well as requirements for data quality and submission to the National Cancer Data Base (NCDB).

The high quality data ensured by this governance improves reimbursement and reduces costs, particularly in an accountable care environment. So, consider who is in charge of collecting the data. Cancer registry data is collected by highly trained Certified Tumor Registrars who have met increasingly strenuous educational requirements, including passing a national certification exam. The CTR certification marks its 30th anniversary in 2013, a testament to the stability and long-term contributions of these highly trained professionals. Once the certification is obtained, registrars must meet continuing education requirements to maintain the CTR credential. CTRs are trained to:

“...correctly interpret and code cancer diagnosis, stage, treatment, and outcomes information for each case...” i i

The use of CTRs for data abstraction ensures that cancer registry data is of the highest quality and executives can trust the data as a reliable source for informed decision making and utilize it to assist in meeting quality parameters in multiple settings.

Value of the cancer registry to the bottom line

Executives should understand what data their cancer registry contains and how that data can be easily extracted and used to help patients and improve the organization’s bottom line. Since data quality directly impacts patient outcomes,

to reduce costs and improve patient outcomes and organizational performance already exists in the cancer registry. Beyond accessing existing data, new fields can be added to the cancer registry data collection process to ensure that any additional required data is accessible moving forward.

Simple steps today, financial rewards tomorrow

The cancer registry data assessment will help executives better understand the current state of their organizations’ cancer registry and what cancer registry data can do for their organizations today. With a solid understanding of the starting point in hand, executives should take the following steps to further enhance the usefulness and future potential of the cancer registry to improve an organization’s performance in a variety of ways.

1 Develop standard reports for data analysis.

These reports can be custom designed on any data parameter collected by the cancer registry and can aid in understanding the who, what, when, where, why and how of an organization’s cancer program.

2 (Executives) Become active and involved in cancer committee meetings where these reports can be presented.

Decisions on program development and improvement can be made given your active involvement in both data analysis review and cancer committee attendance.

3 Ask for data.

Executives are often surprised to discover the amount of data available to them that can aid in their decision making processes.

4 Before conducting a study or chart review on cancer care, seek out the assistance of your cancer registry.

Duplication of effort can be avoided, and many resources can be applied to other more useful efforts.

Cancer registry now... (cont’d)

Prior to the institution of the RQRS, providers received information 18-24 months after treatment rendering the treatment information insufficient to assess quality of care. To address these issues the CoC adopted the RQRS. Currently voluntary, RQRS could become mandatory in the future, which would require accredited cancer programs to report data on patients concurrently and notify hospitals of treatment expectations. Each hospital would then receive its year-to-date concordance rate relative to other similar hospitals at the local, state and national levels.

The CoC has a data use agreement in place to use the clinical information provided by the RQRS for the purposes of quality review and improvement. The revised CoC standards assist hospitals with health care operations, including quality assurance, utilization review and accreditation. As a result, the cancer registry now provides the most accurate and complete source of data on cancer treatment and outcomes available to many health care executives.

Quickly assess the organization’s cancer registry data

To quickly assess the quality of an organization’s cancer registry data and its potential to boost organizational performance today, executives should work with their teams to answer four simple questions:

1 What data do we currently have access to through the cancer registry?

2 What data has been required in the past and is it relevant for use today?

3 What data is needed today in light of new accountability and reporting standards?

4 What, if any, additional data points should we begin collecting to strengthen the registry’s stature as a tool to build the bottom line?

As executives answer these questions, it should become obvious that much of the data they need

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Simple steps today... (cont’d)

5 Monitor timeliness of treatment.

If the average delay between diagnosis and the start of treatment is extended, it could signal a communications breakdown between specialties or a shortage of appointment openings for treatment, and this could be an opportunity for a fast tracking program.

6 Monitor the treatment mix for the primary facilities.

Does the treatment mix mirror national trends? If not, it could mean that patients aren’t being informed of all their options before deciding on a course of treatment; perhaps there is a need for a more thorough patient consultation program.

7 Examine average stage of disease at diagnosis.

Are the organization’s patients being diagnosed at later stages of disease than the benchmarks established at the local, state, or national level? If so, the community may need an early screening program to provide patients and primary care physicians with a better education on early detection.

8 Monitor patient ages.

Determine the primary age groups of patients and compare them to previous data to see if the average age has changed. This will help in planning and scheduling support programs for different patient age groups.

9 Analyze the success of signature services.

Using rapid reporting mechanisms such as the RQRS, executives can compare patients who are eligible for signature services to those who are using them to determine whether the services should be grown (marketed, referred and staffed) or discontinued.

10 Review patient addresses.

By taking a close look at patient addresses, the organization can identify areas where few or no patients reside, potentially signaling an opportunity for extended community and primary care physician outreach.

References:

iCommission on Cancer. Cancer Program Standards 2012: Ensuring Patient-Centered Care. American College of Surgeons. http://www.facs.org/cancer/coc/programstandards2012.pdf. Published September, 2012. Accessed May 20, 2013.

i iCommission on Cancer. Cancer Program Standards 2012: Ensuring Patient-Centered Care. American College of Surgeons. http://www.facs.org/cancer/coc/programstandards2012.pdf. Published September, 2012. Accessed May 20, 2013.

i i iCommission on Cancer. The Rapid Quality Reporting System. American College of Surgeons. http://www.facs.org/cancer/ncdb/rqrs0509.pdf Published April, 2009. Accessed May 20, 2013.

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About the Author

Laurie Hebert, RHIA, CCS, CCS-P, CTR Vice President and General Manager, Cancer Registry Services

800-458-3544, ext. 161 lhebert@care-communications.comwww.carecommunications.com/cancer_registry

As Vice President and General Manager, Cancer Registry Services at Care Communications, Inc., Laurie Hebert is responsible for managing client relationships, cancer registry consultants, and sales of cancer registry services. Hebert also provides input and required oversight for research projects that require cancer registry data. With over 20 years of experience, Hebert has worked at various hospitals and cancer registry facilities in a wide range of health information management (HIM) roles.

She has published or contributed to many articles noted in national trade publications, authored white papers related to the cancer registry field, co-authored a study on pediatric lymphoma, and assisted in the development of a pediatric staging form chosen by the American College of Surgeons Commission on Cancer as a best practice tool for pediatric facilities.

Hebert is currently serving on the National Cancer Registrars Association’s (NCRA) Board of Directors as Advocacy and Technical Practice Director-Midwest along with serving on several additional NCRA related committees, and is the past chair of the association’s National Cancer Registrars Week Committee. She is past president-elect of the Central Louisiana Health Information Management Association and past president of the Southeast Louisiana Health Information Management Association.

Hebert is a member of several health care associations including the American Health Information Management Association (AHIMA), National Cancer Registrars Association, Louisiana Health Information Management Association (LHIMA), the Southwest Louisiana Health Information Management Association (SWLHIMA) and the Louisiana Cancer Registrars Association (LCRA).

She received a bachelor’s degree in psychology and HIM from the University of Southwestern Louisiana.

Areas of Expertise:

l Cancer registry regulations and accreditation

l Cancer registry education and advocacy

l Data management and analysis

l Quality data collection

l Cancer studies

l Outcomes measurement

l Database outcomes improvement

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