ONCOLOGY ISSUES - Association of Community Cancer Centers
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Educating cancer patients Developing a program to meet Helping patients navigate the
on diet and exercise to improve the needs of adolescent and young clinical, psychosocial, and financial
their overall health | 24 adults with cancer | 32 aspects of cancer care | 42
ONCOLOGY
ISSUES
This publication is a benefit of membership
Association of Community Cancer Centers
March | April 2020
Outcomes from a
Community-Based Cancer
Survivorship Program
Association of Community Cancer Centers
ACCC 37th
National
Oncology
Conference
STRATEGIES
FOR THE CANCER CARE TEAM
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contents Oncology Issues
March | April 2020
Vol. 35 | No. 2
24 Supporting Cancer Survivors in Making
Healthful Lifestyle Changes
by Wendy Demark-Wahnefried, Jennifer R. Bail, Teri
Hoenemeyer, Dorothy W. Pekmezi, Maria Pisu, Karina I.
Halilova, Michelle Y. Martin, and Laura Q. Rogers
32 The In-Betweeners: A Focus on
Young Adults with Cancer
16
by Kristin S. Donahue and Anne Marie Fraley Rainey
42 Guided Patient Support
by Jessica Sima, Lora Anderson,
Marianna Wolfmeyer, and Jill Benedeck Impact of a
Community-Based
56 Improving Care Coordination:
A Model for Lung Cancer
Cancer Survivorship
Program on Quality of
Life
68 The
Managing Immunotoxicities in a Virtual Space
The Fort Worth Program for
Virtual Toxicity Team at Community Survivorship uses
Johns Hopkins University a personalized assessment and
referral process to address unmet
70 The
psychosocial needs of cancer
Networking for Health survivors.
Virtual Toxicity Team by Rachel Funk-Lawler, Heidi
Hamann, Laura Howe-Martin,
at Jefferson Health Bijal Balasubramanian, Michael S.
72 The
Businelle, Jeffrey Kendall, Joanne
It Takes a Village
M. Sanders, Sarah N. Price, and
Virtual Toxicity Team at Keith Argenbright
Cleveland Clinic
D E PA RTM E N T S
2 From the Editor | Right to Try: Two Years In 12 Tools | Approved drugs, and more
3 President’s Message | The Year of the Biosimilar 14 Spotlight | Portneuf Cancer Center, Pocatello,
Idaho
4 Fast Facts | Wellness trends to watch in 2020, and more
74 Action | ACCC Welcomes Its Newest Members,
6 Issues | Policy Round Up and more
8 Compliance | Preparing for E/M Changes to Outpatient Visits in 2021 76 Views | The Hairstylist Melanoma Challenge
OI | March–April 2020 | accc-cancer.org 1
FROM THE EDITOR
Right to Try: Two Years In
ONCOLOGY ISSUES BY JENNIE CREWS, MD, MMM, FACP
The Official Journal of the
Association of Community Cancer Centers
M
Editor-In-Chief
Jennie R. Crews, MD, MMM, FACP ay 30, Instead of using Right to Try, many
2020, physicians and manufacturers prefer using
Executive Director
Christian G. Downs, JD, MHA marks the the FDA’s Expanded Access Program, which
Medical Director
two-year anniversa- was established in 1987 and offers some
Leigh Boehmer, PharmD, BCOP ry of the passage of advantages over Right to Try. Expanded Access
Managing Editor the federal Right to has similar eligibility requirements but
Monique J. Marino Try law. Like the ex- provides patients with broader options by
Associate Editors periences in states allowing access to drugs in earlier phases of
Barbara Gabriel that have passed development. The program also provides
Maddelynne Parker similar legislation, third-party oversight and guidance to
Amanda Patton physicians on drug dosing and safety
there was consider-
EDITORIAL BOARD able debate over the benefits versus harms monitoring. The FDA reports that 99 percent
Nadine Barrett, PhD, MA, MS of the applications it receives are approved,
Jennifer Bires, LICSW
that a national Right to Try law would usher
Stephen Cattaneo, MD in. Proponents argued that existing process- usually within a few days. About 20 percent of
Linda Corrigan, MHE, RHIT, CTR es for patients seeking non-U.S. Food and these requests come from oncologists, and in
Sigrun Hallmeyer, MD Drug Administration (FDA)-approved, poten- June 2019 the FDA launched Project Facilitate
Robin Hearne, RN, MS to streamline the Expanded Access Program
Sarah Hudson-DiSalle, PharmD, RPh
tially life-saving medication were arduous,
Jeff Hunnicutt and a more direct approach was needed by providing a single point of contact for
Bridget LeGrazie, APN to improve patient outcomes. Opponents oncology requests.
Anne Marie F. Rainey worried that this law would threaten patient Thus far, it appears that Right to Try has
Bryan Schmalhofer, MBA, RT(R)(T) not substantially benefited patients and is
Kelay Trentham, MS, RDN, CSO
safety, clinical trial enrollment, and stake-
Gretchen Van Dyck holder legal and financial liability. not favored by providers or manufacturers.
Since the passage of Right to Try, reality So, who is benefiting from this law? Perhaps
ACCC EXECUTIVE COMMITTEE
President looks quite different. The law allows patients organizations seeking to monetize this
Ali McBride, PharmD, MS, BCOP with a life-threatening illness who have legislation. A clinical research organization
President-Elect exhausted approved options or are unable to has emerged with plans to broker Right to Try
Randall A. Oyer, MD participate in a clinical trial to receive an access between manufacturers and medical
Secretary investigational drug (that has been through organizations by providing patients with
Krista Nelson, MSW, LCSW, OSW-C, BCD Phase 1 testing) from a manufacturer by medication and collecting real-world data on
Treasurer providing written informed consent to their outcomes. The Access Hope clinical research
David Penberthy, MD, MBA treating physician. However, there is no organization (CRO) was founded by an
Immediate Past President obligation on the part of the physician to attorney with experience in biotech and Right
Thomas A. Gallo, MS, MDA
pursue the request, the manufacturer to to Try legislation. Its website cites benefits of
ACCC Board of Trustees provide the drug, or the insurance company this business model to patients, providers,
Olalekan Ajayi, PharmD, MBA to pay for treatment or treatment-related and sponsors for whom “Right to Try creates
Nadine J. Barrett, PhD, MA, MS complications. The law also offers liability heretofore unthinkable flexibility, legal
Nina K. Chavez, MBA, FACMPE immunity, and time and cost reductions
Amanda Henson, MSHA, MBA, FACHE protections for physicians and manufacturers.
Una Hopkins, DNP, RN, FNP-BC Thus, Right to Try truly is a “right to try,” while creating new data”1 and “truly exclusive
Jeff Hunnicutt leaving patients with little assurance and control over your data.” 1 The website also
Barbara Jensen, RN, BSN, MBA
potentially high risk. It is difficult to know for states that Access Hope also will be exploring
S. Michelle Shiller, DO, MSPT “patient pay” 1 for services and medications.
Lawrence D. Wagman, MD certain how many people have tried to access
Wendi Waugh, RT(R)(T), CMD, CTR, BS investigational drugs under this law because Red flag? Perhaps the concerns originally
there are no mandated reporting require- raised by opponents to Right to Try are
Oncology Issues serves the multidisciplinary
specialty of oncology care and cancer ments. News outlets cite two patients who founded after all.
program management. have used Right to Try—one with glioblas- Reference
toma and one with Lou Gehrig’s disease. It is 1. Access Hope CRO. For Sponsors/CROs.
Oncology Issues (ISSN: 1046-3356) is published
bimonthly for a total of 6 issues per year by
unknown whether either benefited from the Available online at ahcro.com. Last accessed
Taylor & Francis Group, LLC, 530 Walnut Street, treatments they accessed. February 18, 2020.
Suite 850, Philadelphia, PA 19106, on behalf of the
Association of Community Cancer Centers (ACCC),
1801 Research Blvd, Suite 400, Rockville, MD 20850-
3184, USA. US Postmaster: Please send address
changes to Oncology Issues, c/o The Sheridan Press,
PO Box 465, Hanover, PA 17331. Copyright © 2020
by the Association of Community Cancer Centers. All
rights reserved. No part of this publication may be
reproduced, stored, transmitted, or disseminated in any
form or by any means without prior written permission
from the publisher, Taylor & Francis Group, LLC.
2 March–April 2020 | OI
ACCC PRESIDENT’S MESSAGE Coming in Your 2020
The Year of the Biosimilar ONCOLOGY ISSUES
BY ALI MCBRIDE, PHARMD, MS, BCOP “Prescribing” Exercise and
Nutrition in Cancer Care
W
Medical Marijuana
ith the effective biosimilar implementation vary
(Cannabinoid-Derived Products)
advent based on the size and resources of the specific
of program and can include: for Cancer Patients
biologics decades • State and federal legislation
Developing a Model of Risk
ago, the practice of • Reimbursement and coverage challenges
oncology was • Electronic health record processes and Modification for Breast Cancer
forever changed. integration issues Using Integrative Oncology
Today, the United • Insufficient or ineffective education for
States has the healthcare team members and patients Helping Patients Navigate the
largest market for • Pharmacy and therapeutics (P&T) Clinical, Psychosocial, and
biologics in the integration Financial Aspects of Cancer Care
world, accounting for nearly 50 percent of all • Pharmacovigilance processes and an
prescription drug expenditures. This class of understanding of biosimilar outcomes, Telemedicine Improves Access
drugs also represents the nation’s fastest which have been associated with a lack of to Supportive Group
growing pharmaceutical sector. More than 80 knowledge of biosimilars
percent of the revenue from biologic therapy • Uncertainty around therapeutic outcomes. Psychotherapy for Young Adults
is derived from oncology indications, and this As we move into this new decade, biosimilars with Cancer
percentage is expected to increase in coming represent terrific innovation and (as yet)
years as the use of these essential drugs Electronic Multidisciplinary
unrealized potential for cost savings. Use of
expands throughout clinical care. These these therapies may help cancer programs Conference (eMDC): Case
trends are not limited to the United States, improve access to care, reduce total health- Planning in the Virtual Space
however, as the global biologics market is care expenditures, and meet alternative
expected to top $100 billion by 2023.1 payment model goals and requirements. If we
Developing and Implementing
The Biologics Price Competition and are to realize the full potential of these a Radiation Oncology App to
Innovation Act of 2009, which created an therapies, however, integration of biosimilars
abbreviated pathway to approval for
Improve the Patient Experience
is critical and must be achieved through
biosimilar agents, was designed to increase interdisciplinary education of the entire Cancer Life reiMagined: The
competition with reference biologics to lower cancer team—from physicians and nurses to CaLM Model of Whole-Person
prices, increase patient access, and accelerate pharmacy staff to financial navigators and
innovation. Anticipated cost savings with the Cancer Care
patients and beyond. We can all play a vital
introduction of biosimilars in the U.S. market role in the education, advocacy, and safety Implementing Genetic Cancer
was estimated to be from $40 billion to $250 needs inherent with this new class of
billion over the following 10 years.2 The added Screening and Testing in a
anti-cancer therapies.
advantages of biosimilar implementation Medically Underserved
under alternative payment models, such as References
Community
the Oncology Care Model and Merit-Based 1. GBI Research. Global immunology market
Incentive Payment System are still yet to be to surpass $100 billion by 2023. Available Reducing Revenue Loss and
fully realized. online at: gbiresearch.com/media-center/
Patient Financial Toxicity with
To date, more than 25 biosimilars have press-releases/global-immunology-
been approved by the U.S. Food and Drug market-to-surpass-100-billion-by-2023. Last Pharmacy Pre-Certification and
Administration (FDA), including rheumatol- accessed February 18, 2020. Denials Management
ogy therapies, oncology supportive care 2. Deloitte. Winning with biosimilars:
agents, and therapeutic oncology drugs. The opportunities in global markets. Available Food Security: A Key
first biosimilar, filgrastim-sndz, was approved online at: www2.deloitte.com/content/dam/ Component in One Practice’s
in 2015, and as of early 2018 more than 60 Deloitte/us/Documents/life-sciences-health- Financial Advocacy Program
biosimilars were enrolled in the FDA’s care/us-lshc-biosimilars-whitepaper-final.pdf.
biosimilar development program.3 Despite Last accessed February 18, 2020. Researching the Use of Virtual
this aggressive approval and development 3. Dolan C. Opportunities and challenges in Reality (VR) in the Oncology
landscape, integration of biosimilars into the biosimilar uptake in oncology. Am J Manag
U.S. market has been slow. Barriers to Care. 2018;4(11):S237-S243. Infusion Clinic
Optimizing Provider Access in
the Rural Healthcare Setting by
Utilizing a Physician-Advanced
Practice Provider Model
OI | March–April 2020 3
more online @
accc-cancer.org
Trending Now in Cancer Care
RESOURCE As the demand for cancer services rises in the U.S.,
cancer programs continue to rank three factors as top chal-
fast
Executive
lenges to growth: payer reimbursement requirements, the Physician Wellness
Leaders Needed
move to value-based payments, and uncertainties in drug
pricing reform policies. In ACCC’s 2019 survey, the vast majority
(88%) of respondents selected improving care coordination as STAT!
a top opportunity for cost savings. Other areas identified for
cost savings opportunities included: improving symptom
management (85%); utilization of lower cost drugs through
In a 2019 consensus paper, the
implementation of pathways (76%); and reducing variations in
care (72%). Read key findings at accc-cancer.org/trends. National Academy of Medicine’s
Action Collaborative on Clinician
Pursuing Quality Cancer Care for Well-Being and Resilience recommended
BLOG Sexual and Gender Minority Patients an executive level physician wellness leader in ALL healthcare delivery
These patients are often misrepresented or overlooked in
healthcare. Although social acceptance has grown for sexual organizations. Most organizations have no such leader and
and gender minority communities, LGBTQ-specific health risks many believe there is a shortage of qualified candidates to draw from.
and recommended screenings are not consistently taught to
healthcare providers and patients. One way to improve care of Source. NAM. Taking Action Against Clinician Burnout: A Systems Approach to Professional
Well-Being. Available online at nap.edu/catalog/25521 taking-action-against-clinician-
this patient population is to promote and collect sexual and burnout-a-systems-approach-to-professional.
gender minority information whenever patient demographics
are collected, for example adding language that asks patients
their preferred name and pronouns to create gender-neutral
intake forms. Read more at accc-cancer.org/acccbuzz-SGM. Top 4 Challenges Managers Face
• Juggling management of my team with my other
The Immunotherapy Patient
PODCAST Perspective responsibilities—68%
Journalist Mary Elizabeth Williams, one of the first patients • Hitting team goals—14%
treated with combination immunotherapy, discusses her
experience as an immunotherapy patient and how to bridge • Getting my team to collaborate with one another—11%
communication gaps among patients, providers, and research-
• Retaining my employees—4%
ers. At the ACCC 36th National Oncology Conference, Williams
shared that communication boils down to “making sure Source. 2019 State of
patients and providers are on the same page. Telling the same One-on-Ones Report.
soapboxhq.com/state-
stories, because stories are how we make decisions. Communi-
of-one-on-ones-report.
cation is about empathy and being clear. It’s not optional.”
Hear more at accc-cancer.org/podcast.
BiomarkerLIVE Resource Library
WEBINAR and Lexicon
The important role that biomarkers and molecular profiling
play in cancer diagnosis and treatment continues to
grow, but keeping pace with this rapidly evolving field can
be challenging. ACCC’s BiomarkerLIVE program puts a
library of resources and a comprehensive glossary of terms
at your fingertips, giving you the knowledge and tools to
discuss biomarker testing with colleagues and patients.
The BiomarkerLIVE Advisory Committee has developed
a webinar on how to use these valuable tools, with expert
review of the current cancer biomarker landscape and three
case examples. Learn any time, anywhere! accc-cancer.org/
biomarker-live-webinar.
4 accc-cancer.org | March–April 2020 | OI
facts
5 Wellness Trends
to Watch in 2020
Physicians
Give EHRs
an “F” Grade
In a recent study, the usability of current EHR systems received a
grade of “F” by physician users. The same study found a strong
relationship between EHR usability and physician burnout. Study
authors recommend, “Given the association between EHR usability
and physician burnout, improving EHR usability may be an
important approach to help reduce healthcare professional burnout.”
Source. Melnick ER, et al. The association between perceived electronic health record usability
and professional burnout among U.S. physicians. Mayo Clinic Proc. DOI: 10.1016/j.
1. Financial Wellness. With 64% of Americans mayocp.2019.09.024.
experiencing stress about money,1 more employers are offering
financial wellness programs to educate employees and help
improve employee health and productivity. Generational Differences
2. Technology Integration. As wearables and online
in Physician Burnout
platforms allow users to sync data in real-time, more • 48% of Generation X physicians report burnout,
employers will move to mobile platforms for health interac- compared to 39% of Baby Boomer physicians and 38%
tions. Allowing employees to connect with their health info via of Millennial physicians.
mobile platforms make employer health programs more
• 50% of Baby Boomer physicians say that burnout has had
accessible to remote employees.
a strong and/or severe impact on their lives, compared to 46%
3. Wellness at Work. From company walking groups to of Generation X physicians and 38% of Millennial physicians.
onsite fitness facilities, more employers are seeing the
• 77% of Millennial physicians say that burnout has impacted
benefits of small investments, like standing desks and
their relationships, compared to 73% of Generation X physicians
healthier food options in breakrooms.
and 69% of Baby Boomer physicians.
4. Flexible Work/Life Balance. Advanced technology
Source. Medscape National Physician Burnout & Suicide Report 2020. medscape.com/
and an always-on culture means that work isn’t restricted to slideshow/2020-lifestyle-burnout-6012460?faf=1#1.
an office or from 9-5. More employers are embracing flexible
working hours and remote work in response to Gen Z and
Millennials pushing for greater work/life balance.
5. Health Coaching. More employers will add health
coaches to their benefits. These coaches can help employees
set goals, identify obstacles, and find solutions, creating
healthier, more productive workplace cultures.
Source. StayWell Shares Top 5 Employer Wellness Trends in 2020. staywell.com.
staywell.com/news/top-5-employer-wellness-trends-in-2020.
1 American Psychological Association. Stress in America: Paying With Our Health. apa.
org/news/press/releases/stress/2014/stress-report.pdf.
OI | March–April 2020 | accc-cancer.org 5
issues
Policy Round Up
BY CHRISTIAN G. DOWNS, JD, MHA
I
n this election year, U.S. healthcare policy remains a topic of great interest to ACCC ability to determine coverage of next-
is center stage. To help its members keep member programs. Data from the 2019 generation sequencing laboratory tests for
current on recent policy issues that may ACCC Trending Now in Cancer Care Survey other inherited cancers.
affect their programs and patients, ACCC found that in the next two years, 35
provides a brief update. percent of cancer programs plan to use Importation of Prescription
telehealth for delivery of genetic Drugs
CY 2021/2022 Medicare As part of the administration’s push to lower
counseling (already difficult to access in
Advantage and Part D Proposed prescription drug prices, the FDA released a
rural areas), 28 percent for symptom
Rule proposed rule and draft guidance on drug
consults, 28 percent for oral chemother-
On Feb. 5, the Centers for Medicare & importation into the United States. The
apy adherence and support, 28 percent for
Medicaid Services (CMS) released CMS- proposed rule would authorize states,
symptom monitoring (e.g., through an
4190-P, which would: wholesalers, or pharmacists to submit
app), 24 percent for psychosocial
• Require Part D plans to offer real-time proposals to import prescription drugs from
counseling, and 22 percent for nutrition
drug price comparison tools to beneficia- Canada into the United States. The rule
counseling.
ries starting Jan. 1, 2022, to allow excludes importation of biologics and
consumers to shop for lower-cost Comment deadline on the proposed rule is infused drugs.
alternative therapies under their April 6, 2020. The FDA issued draft guidance that
prescription drug benefit plan. Together with the Medicare Advantage describes pathways that drug manufacturers
• Allow a second, “preferred” specialty tier and Part D proposed rule, CMS released the would use to import prescription drugs
in Part D with a lower cost-sharing 2021 Medicare Advantage and Part D (including biologics) into the United States
amount. Advance Notice Part II, in which the agency that are FDA approved, manufactured abroad,
• Require Part D plans to disclose the solicits comments on potentially developing and originally intended for sale in a foreign
measures they use to evaluate pharmacy measures of generic and biosimilar utiliza- country.
performance in their network agree- tion in Medicare Part D as part of a plan’s The proposed rule comes after the Dec. 28,
ments. This would allow CMS to track and star rating. Comment deadline on Advance 2019, administration release of a notice of
report publicly how plans are measuring Notice Part I and Part II proposals was Friday, proposed rulemaking on drug importation
and applying pharmacy performance March 6, 2020. and draft guidance. These actions follow the
measures. administration’s “Safe Importation Action
• Strengthen network adequacy rules for Coverage for Diagnostic Tests Plan,” released in July 2019, which laid out
Medicare Advantage plans by codifying Using Next-Generation pathways for importing certain prescription
CMS’s existing network adequacy Sequencing drugs into the United States.
methodology. The proposed rule has On Jan. 27, 2020, CMS issued a National
provisions addressing access to care in Coverage Determination that expands 340B Under Scrutiny
rural areas and encouraging use of coverage of U.S. Food and Drug Administra- In early January, the Government Account-
telehealth in all areas. For rural areas, the tion (FDA)-approved laboratory diagnostic ability Office (GAO) released a report calling
agency proposes to lower the percentage tests that use next-generation sequencing on the Health Resources and Services
of beneficiaries required to live within the for patients with germline, or inherited, Administration (HRSA), an agency of the U.S.
maximum time and distances standards ovarian or breast cancer. CMS also gave Department of Health and Human Services
from 90 percent to 85 percent. Telehealth Medicare Administrative Contractors the (HHS), to improve processes for assuring that
6 accc-cancer.org | March–April 2020 | OI
participating non-governmental hospitals HRSA lacks the authority to determine the • Provide more details and future opportu-
meet 340B Drug Pricing Program eligibility adequacy and appropriateness of state nities to comment on the Oncology Care
requirements. The GAO report recommends Medicaid policies and procedures to prevent First Model before finalizing the model.
that HRSA: duplicate discounts. On Jan. 8, 2020, CMS Read the full letter at accc-cancer.org/
• Implement a process to verify that all issued guidance on “Best Practices for advocacy.
non-governmental hospitals have Avoiding 340B Duplicate Discounts in
contracts in place, including throughout Medicaid” (medicaid.gov/sites/default/files/ Medicaid Block Grants: Impact
Federal-Policy-Guidance/Downloads/ on Cancer Patients
hospitals’ audit periods.
cib010820.pdf). On Jan. 29, 2020, CMS released guidance that
• Amend its contract reviews to include an
would permit states to receive a block grant
assessment of whether contracts meet
statutory requirements. ACCC Response to Center for for adults not otherwise eligible for Medicaid
• Provide better guidance on contract Medicare and Medicaid (i.e., adults younger than age 65). Dubbed the
Innovation on Oncology Care “Healthy Adult Opportunity,” the agency is
reviews.
First Model referring to the plan as a demonstration. In
HHS agreed with the GAO recommendations ACCC provided comments to the Center for accepting the block grant—capping the
except for the recommendation to set up a Medicare and Medicaid Innovation’s (CMMI) state’s federal funding for Medicaid
process to verify that all non-governmental request for information on its concept for the beneficiaries—the state would have greater
hospitals have contracts in place. HHS says Oncology Care First Model. Though applaud- flexibility in determining benefits’ coverage
that HRSA does not have the resources to ing CMMI for making the Oncology Care First and benefit from a less cumbersome process
carry out the recommended verification Model voluntary and envisioning a multi- for adding work requirements and other
process and that it would over-burden the payer model, ACCC urged CMMI to: restrictions. Oncology stakeholders, along
agency. • Make significant changes to the risk with patient advocacy groups, expressed
Later in January, the GAO issued a second tracks for purposes of performance-based concerns that transformation of Medicaid
340B report calling on HRSA and CMS to take payment episodes. through block grants could reduce access to
care and result in the rationing of services for
action to prevent drug manufacturers from • Structure the prospective payment for
the most vulnerable patient populations. As
paying duplicate discounts under Medicaid care management and certain other
with Medicaid work requirements, the
and the 340 Drug Pricing Program. In services as a supplemental payment.
agency’s legal authority to push this plan
response, HHS and 340 participating • Provide more detail on the methodology
forward is likely to be the subject of
hospitals asserted that HRSA cannot legally for the novel therapy adjustment and
litigation.
follow the GAO’s request to examine states’ ensure that the final adjustment
duplicate discount prevention policies and adequately accounts for the cost of Christian G. Downs, JD, MHA is executive
procedures and then act to enforce these if innovative and often life-saving new director, Association of Community Cancer
providers do not comply. CMS states that therapies. Centers, Rockville, Md.
OI | March–April 2020 | accc-cancer.org 7
compliance
Preparing for E/M Changes
to Outpatient Visits in 2021
BY TERI BEDARD BA, RT(R)(T), CPC
T
here is no argument that the At the same time, the American Medical Straightforward
Evaluation and Management (E/M) Association (AMA) convened a taskforce • Self-limited.
coding guidelines are in need of an dedicated to updating the E/M CPT® codes. • Minimal or no data review and/or
update. The Centers for Medicare & Medicaid The AMA came up with guidelines based analyzed.
Services (CMS) has not updated E/M solely on medical decision-making (MDM) • Minimal risk from treatment (including
guidelines since 1997, with many providers and time, as well as a dedicated prolonged no treatment) or testing. (Most would
and coders still following the 1995 guide- services code specific to outpatient E/M consider this effectively as no risk.).
lines. The use of electronic health records visits. This meant that history and/or
physical exam would no longer be used to Low
(EHRs) has prompted requests for updates.
determine the billable level. In an about-face, • Stable, uncomplicated, single problem.
The ability to copy and paste documentation • Two documents or independent historian.
CMS did away with most, but not all, of the
from another provider’s visit notes and • Low risk (i.e., very low risk of anything
changes finalized in the CY2019 PFS rule and
templates, which incorporate full documen- bad), minimal consent/discussion.
instead aligned with those established by
tation of the Review of Systems and Physical
the AMA. The agency’s decision allows for
Exam, can result in documentation that is consistency and continuity of coding and Moderate
more complex than what took place during billing for all patients across all payers. • Multiple problems or significantly ill.
the encounter, creating issues not foreseen Because most commercial and private payers • Count: Three items between documents
in 1995 or 1997. follow AMA guidelines when using CPT and independent historian, or interpret or
It is not uncommon to see E/M visit notes codes, it made sense for CMS to do the same confer.
run pages long and with no clear documen- and not create more work and confusion for • Would typically review with patient/
tation of what is actually new and part of the providers. surrogate, obtain consent and monitor, or
patient encounter. Additionally, the ability to At the Resource-Based Relative Value Scale there are complex social factors in
pull in statements from elsewhere in the EHR Symposium in Nov. 2019, the AMA provided management.
creates an issue with continuity, because updated definitions, time ranges, and MDM
criteria for the outpatient E/M codes
High
these statements may be old or outdated • Very ill.
and no longer pertain to the patient’s (99202-99215) that go into effect Jan. 1,
• Same concepts as Moderate.
current situation, resulting in contradictory 2021. The following is a summary of the
• Discussion includes difficult topics or
documentation. changes for CY 2021 as we know them now,
decisions for the very ill patient that could
To solve this, CMS issued sweeping with the expectation that more updates and
happen for which physician or other
changes to the outpatient visit codes information may come during the CY 2021
qualified healthcare professional will
(99201-99215) in the CY 2019 Medicare CMS rulemaking cycle, as well as AMA coding
watch or monitor.
Physician Fee Schedule (MPFS) Final Rule, updates for the CY 2021 CPT Manual.
Beginning Jan. 1, 2021, practitioners will When counting the number and/or
CMS-1715-F, which go into effect Jan. 1, complexity of data reviewed and analyzed,
select either MDM or time on which to base
2021, including collapsing visit levels from three different categories are part of the
their documentation and coding.
three individual reimbursed rates to one. MDM:
Based on stakeholder feedback that showed MDM Criteria • Tests, documents, orders, or independent
that many disagreed with these reimburse- Providers who select MDM for documenta- historian(s)—each unique test, order, or
ment changes, the agency convened tion and coding can select from four levels, document is counted to meet a threshold
additional stakeholder meetings. using these updated AMA parameters: number.
8 accc-cancer.org | March–April 2020 | OI• Independent interpretation of tests is not
reported separately.
• Discussion of management or test
interpretation with external physician/
other qualified healthcare professional/
appropriate source (not reported
separately).
Time-Based Criteria
Providers who use the time-based parameter
must understand that more is required than
just the mention of the total time spent on
the date of the encounter. Documentation
must include and support all of the work
provided to which time was attributed on
that date of service by the billing practitioner
and may not include ancillary staff time. The
AMA stresses that the following items are to
be accounted for and/or included when
using the time-based option:
• Preparing to see the patient (e.g., review
of tests)
• Obtaining and/or reviewing separately
obtained history CPT 99201 will be deleted effective Jan. 1, definition, but more is expected at the time
• Performing a medically necessary 2021. of the 2021 MPFS rulemaking cycle. Code
appropriate examination and/or GPC1X (the full Healthcare Common
evaluation Prolonged Services Code
Procedure Coding System code will be
• Counseling and educating the patient/ A new prolonged services code will be
released by CMS) is defined as visit complex-
family/caregiver available Jan. 1, 2021, that is only for use
ity inherent to E/M associated with medical
• Ordering medications, tests, or with level 5 outpatient visit codes, 99205
care services that serve as the continuing
procedures and 99215. Updates will be made to codes
focal point for all needed healthcare services
• Referring and communicating with other 99358 and 99359 and providers will no
and/or with medical care services that are
healthcare professionals (when not longer be allowed to bill them in addition to
part of ongoing care related to a patient’s
reported separately) the new and established outpatient visits.
single, serious, or complex chronic condition.
• Documenting clinical information in the This new code has not been assigned a full
(Add-on code, list separately in addition to
electronic or other health record CPT number, but the definition for the new
office/outpatient evaluation and manage-
• Independently interpreting results (not 99xxx code will be prolonged office or other
ment visit, new or established.)
reported separately) and communicating outpatient evaluation and management
As CY 2021 comes closer, more education
results to the patient/family/caregiver service(s) (beyond the total time of the
primary procedure that has been selected and information from both the AMA and
• Care coordination (not reported
using total time), requiring total time with or CMS is needed to help providers adjust to
separately).
without direct patient contact beyond the these new E/M guidelines. Both organiza-
The AMA also notes that practitioners should tions understand the need for the change
usual service on the date of the primary
make every effort to improve their ability to and are developing resources to assist
service; each 15 minutes (list separately in
document electronically in the EHR to avoid providers and coders in understanding these
addition to codes 99205, 99215 for office or
penalizing the patient and payer by charging big changes so that everyone starts off with
other outpatient E/M services).
a higher level of code billed. their best foot forward in this new E/M
Tables 1 and 2, page 10, list the updated Complexity Code landscape.
definitions and time-based ranges for these In 2021 CMS is adding a complexity code as
new patient visits, 99202-99205, and an add-on to the E/M outpatient codes. This Teri Bedard, BA, RT(R)(T), CPC, is director,
established patient visits, 99211-99215. new code is a revision of language finalized Client Services at Coding Strategies, Inc.,
These will replace the current definitions and in the CY 2019 MPFS final rule. At present not Powder Springs, Ga., and Revenue Cycle,
time ranges used in CY 2020. much is known about this code beyond the Inc., Cedar Park, Tex.
OI | March–April 2020 | accc-cancer.org 9Table 1. New Patient Visit Code Updates for 2021
TOTAL TIME IN MINUTES
CPT CODE DEFINITION
ON DATE OF ENCOUNTER
99201 Deleted for 2021 N/A
Office or other outpatient visit for the evaluation and
99202 management of a new patient, which requires a medically appropriate history and/or 15-29
examination and straightforward medical decision-making.
Office or other outpatient visit for the evaluation and management of a new patient,
99203 which requires a medically appropriate history and/or examination and low level of 30-44
medical decision-making.
Office or other outpatient visit for the evaluation and management of a new patient,
99204 which requires a medically appropriate history and/or examination and moderate 45-59
level of medical decision-making.
Office or other outpatient visit for the evaluation and management of a new patient,
99205 which requires a medically appropriate history and/or examination and high level of 60-74
medical decision-making.
Table 2. Established Patient Visit Code Updates for 2021
TOTAL TIME IN MINUTES
CPT CODE DEFINITION
ON DATE OF ENCOUNTER
Office or other outpatient visit for the evaluation and management of an estab-
No time is part of this code
99211 lished patient, which may not require the presence of a physician or other qualified
in 2021
healthcare professional. Usually, the presenting problem(s) are minimal.
Office or other outpatient visit for the evaluation and management of an estab-
99212 lished patient, which requires a medically appropriate history and/or examination 10-19
and straightforward medical decision-making.
Office or other outpatient visit for the evaluation and management of an estab-
99213 lished patient, which requires a medically appropriate history and/or examination 20-29
and low level of medical decision-making.
Office or other outpatient visit for the evaluation and management of an estab-
99214 lished patient, which requires a medically appropriate history and/or examination 30-39
and moderate level of medical decision-making.
Office or other outpatient visit for the evaluation and management of an estab-
99215 lished patient, which requires a medically appropriate history and/or examination 40-54
and high level of medical decision-making.
10 accc-cancer.org | March–April 2020 | OIAccess the most essential abstracts
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This activity is supported in part by educational grants from Astellas and Seattle Genetics;
Amgen; Celgene Corporation; Daiichi Sankyo, Inc.; Lilly; Merck & Co., Inc. and TESARO, Inc.tools
Approved Drugs (enfortumab vedotin-ejfv) (Astellas seeking approval of belantamab
Pharma Inc. and Seattle Genetics, Inc., mafodotin (GSK2857916) for the
• On Jan. 9, 2020, the U.S. Food and Drug astellas.com, seattlegenetics.com) for the treatment of patients with relapsed or
and Administration (FDA) approved treatment of adult patients with locally refractory multiple myeloma whose prior
Ayvakit™ (avapritinib) (Blueprint advanced or metastatic urothelial cancer therapy included an immunomodulatory
Medicines, blueprintmedicines.com) for who have previously received a PD-1/L1 agent, a proteasome inhibitor, and an
the treatment of adults with unresect- inhibitor and a platinum-containing chemo- anti-CD38 antibody.
able or metastatic gastrointestinal therapy before or after surgery or in a
stromal tumor harboring a platelet- • AstraZeneca (astrazeneca.com)
locally advanced or metastatic setting.
derived growth factor receptor alpha exon announced that the FDA has granted
18 mutation, including PDGFRA D842V • On Jan. 23, 2020, the FDA granted orphan drug designations to PD-L1
mutations. accelerated approval to Tazverik™ Imfinzi® (durvalumab) and anti-CTLA4
(tazemetostat) (Epizyme, Inc., epizyme. antibody tremelimumab for liver cancer.
• On Dec. 20, 2019, the FDA granted com) for the treatment of adults and
accelerated approval to Enhertu® • Kite (kitepharma.com) announced that it
pediatric patients aged 16 years and older
(fam-trastuzumab deruxtecan-nxki) has submitted a BLA to the FDA for the
with metastatic or locally advanced
(Daiichi Sankyo, daiichisankyo.com) for investigational chimeric antigen receptor
epithelioid sarcoma not eligible for
patients with unresectable or metastatic (CAR) T-cell therapy, KTE-X19, for the
complete resection.
human epidermal growth factor receptor treatment of adult patients with relapsed
2 (HER2)-positive breast cancer who have • On Dec. 16, 2019, the FDA approved or refractory mantle cell lymphoma.
received two or more prior anti-HER2- Xtandi® (enzalutamide) (Astellas Pharma
• CytoDyn (cytodyn.com) filed for break-
based regimens in the metastatic setting. Inc., astellas.com) for patients with
through therapy designation for its
metastatic castration-sensitive prostate
• On Jan. 8, 2020, the FDA approved targeted therapy, leronlimab (PRO 140),
cancer.
Keytruda® (pembrolizumab) (Merck, as an adjuvant therapy for the treatment
of metastatic triple-negative breast
merk.com) as a monotherapy for the Drugs in the News
treatment of patients with bacillus cancer.
Calmette-Guérin unresponsive, high-risk, • The FDA has approved an investigational • Bristol-Myers Squibb (bms.com)
non-muscle-invasive bladder cancer with new drug application for a phase 1 trial of submitted a BLA to the FDA for
carcinoma in situ with or without ACE1702 (Acepodia, acepodia.com), a Lisocabtagene Maraleucel (liso-cel),
papillary tumors, who are ineligible for or targeted cancer therapy created by a its autologous anti-CD19 CAR T‑cell
have elected not to undergo cystectomy. proprietary chemical process that directly immunotherapy including individually
links anti-tumor antibodies to the surface formulated CD8+ and CD4+ CAR T-cells for
• On Dec. 27, 2019, the FDA approved of natural killer cells. It will soon enter
Lynparza® (olaparib) (AstraZeneca and the treatment of adult patients with
in-human clinical trials in HER2-positive relapsed or refractory large B-cell
Merck, astrazeneca.com, merck.com) for
solid tumors. lymphoma after at least two prior
the maintenance treatment of adult
patients with deleterious or suspected • Amgen (amgen.com) and Allergan plc. therapies.
deleterious germline BRCA-mutated (allergan.com) announced the submis- • AstraZeneca (astrazeneca.com) and
metastatic pancreatic adenocarcinoma sion of a biologics license application Merck (merck.com) announced that a
whose disease has not progressed on at (BLA) to the FDA for ABP 798, a biosimilar supplemental new drug application for
least 16 weeks of a first-line plati- candidate to Rituxan® (rituximab). Lynparza® (olaparib) in combination with
num-based chemotherapy regimen. • GlaxoSmithKline (gsk.com/en-gb) bevacizumab has been accepted and
• On Dec. 18, 2019, the FDA granted announced that the FDA has granted granted priority review by the FDA for the
accelerated approval to Padcev™ priority review for the company’s BLA maintenance treatment of patients with
advanced ovarian cancer who are in
12 accc-cancer.org | March–April 2020 | OIcomplete or partial response to first-line patients with relapsed or refractory acute (selinexor) as a new treatment for
platinum-based chemotherapy with myeloid leukemia. patients with relapsed or refractory
bevacizumab. The FDA has accepted and diffuse large B-cell lymphoma after at
• Eli Lilly (lilly.com) announced that the FDA
granted priority review to a second least two prior multi-agent therapies
granted priority review for an NDA for
supplemental new drug application for and who are ineligible for stem cell
selpercatinib (LOXO-292) for the
Lynparza® (olaparib) for patients with transplantation, including CAR T-cell
treatment of patients with advanced RET
metastatic castration-resistant prostate therapy.
fusion-positive non-small cell lung
cancer and deleterious or suspected
cancer, RET-mutant medullary thyroid
deleterious germline or somatic
cancer, and RET fusion-positive thyroid Approved Genetic Tests and
homologous recombination repair gene
cancer. Assays
mutations who have progressed
following prior treatment with a new • Roche (roche.com) announced the • Myriad Genetics, Inc. (myriad.com)
hormonal agent. submission of a supplemental BLA to the announced that the FDA has approved
FDA for Tecentriq® (atezolizumab) in BRACAnalysis CDx® for use as a
• MacroGenics, Inc. (macrogenics.com)
announced that it has submitted a BLA combination with Avastin® (bevaci- companion diagnostic test by healthcare
for margetuximab, an investigational, zumab) (Genentech, gene.com) for the professionals to identify patients with
Fc-engineered, monoclonal antibody that treatment of patients with unresectable metastatic pancreatic cancer who have a
targets HER2, for the treatment of hepatocellular carcinoma who have not germline BRCA mutation and are
patients with metastatic HER2-positive received prior systemic therapy. candidates for treatment with PARP
breast cancer in combination with • Kura Oncology, Inc. (kuraoncology.com) inhibitor Lynparza® (olaparib).
chemotherapy. announced that the FDA has granted fast • IceCure Medical Ltd. (icecure-medical.
• OBI Pharma, Inc. (obipharma.com) track designation to tipifarnib for the com) announced that it received FDA
announced that the FDA has granted treatment of patients with HRAS-mutant clearance for expanded indications of
orphan drug designation to OBI-999 for head and neck squamous cell carcinomas Cryoablation Technology, a non-
the treatment of gastric cancer. after progression on platinum therapy. surgical liquid nitrogen cryoablation
• Seattle Genetics, Inc. (seattlegenetics. technology that destroys benign and
• Bristol-Myers Squibb (bms.com)
announced that the FDA has accepted com) announced that it has submitted an cancerous tumors by freezing. The new
and granted priority review to its NDA to the FDA for tucatinib in combina- FDA clearance will enable the company
supplemental BLA for Opdivo® tion with trastuzumab and capecitabine to market its solution for the treatment
(nivolumab) in combination with for treatment of patients with locally of cancerous and benign tumors of the
Yervoy® (ipilimumab) for the first-line advanced unresectable or metastatic kidney; liver; and ear, nose, and throat;
treatment of patients with metastatic or HER2-positive breast cancer, including and further neurology indications.
recurrent non-small cell lung cancer with patients with brain metastases, who have • Myriad Genetics, Inc. (myriad.com)
no epidermal growth factor receptor or received at least three prior HER2-directed announced submission of a supple-
anaplastic lymphoma kinase genomic agents separately or in combination in mentary premarket approval applica-
tumor aberrations. the neoadjuvant, adjuvant, or metastatic tion to the FDA for its myChoice® CDx
setting.
• Precigen, Inc. (precigen.com) announced test to help predict outcomes of
that the FDA has granted orphan drug • Karyopharm Therapeutics Inc. (karyo- women with first-line platinum-
designation to PRGN-3006, an investiga- pharm.com) announced that it has responsive advanced ovarian cancer
tional therapy using Precigen’s non-viral submitted an NDA to the FDA seeking treated with PARP inhibitor Zejula®
UltraCAR-T™ therapeutic platform for accelerated approval for Xpovio® (niraparib).
OI | March–April 2020 | accc-cancer.org 13spotlight
Portneuf Cancer Center
Pocatello, Idaho
P
ortneuf Cancer Center calls Pocatello, clinic is the “hub” of the cancer center and is multidisciplinary breast clinic, which allows
Idaho, home. It overlooks the adjacent to the radiation oncology suite. It patients to meet with their medical
sprawling valley of the Portneuf River features 10 exam rooms and a laboratory oncologist, radiation oncologist, and surgeon
that leads to a beautiful reservoir. Surround- draw station. all in one visit. The nurse navigator is key to
ing mountains create panoramic views in Radiation oncology services are located this coordinated planning and responsible for
every direction. The cancer center, which opposite to the outpatient clinic and infusion ensuring that any extra testing is scheduled
opened in 2004, is located in its own suite. The cancer center boasts an Elekta and completed before the clinic visit.
single-story building on the campus of Infinity™ linear accelerator, cone beam Individuals with colon or rectal cancer follow
computed tomography scanner, and large a similar patient flow, and the aim with all
Portneuf Medical Center and operates as a
bore computed tomography scanner. other patients is to meet the cancer center’s
hospital outpatient department. The cancer
Patients can receive a range of treatments, goal of scheduling a consultation within
center treats patients from southeastern
including 3D conformal, intensity-modulated three to five days of the initial referral.
Idaho and cares for a diverse rural
radiation therapy, volumetric-modulated arc The cancer center takes pride in its
population. multidisciplinary approach to cancer care
therapy, image-guided radiation therapy,
stereotactic body radiation therapy, and and the variety of supportive services it
Under One Roof
stereotactic radiosurgery. The radiation provides patients. (Patients can take
Patients at Portneuf Cancer Center do not
oncology suite is staffed by three radiation advantage of these services at any point
have to travel to separate locations for
therapists, one medical dosimetrist, and one during their treatment journey.) All patients
care—medical oncology, radiation oncology,
medical physicist. meet with the program’s social worker and
dietitians, and a social worker all provide care full-time dietitian at the start of their
In addition to the infusion suite nurses
under the same roof. “The beautiful thing treatment. The dietitian establishes a good
and radiation suite, the Portneuf Cancer
about this is that when patients walk into Center is staffed by two medical oncologists, nutritional base for patients, who may
the cancer center, our staff knows their name two radiation oncologists, three certified schedule follow-up visits, if necessary.
and the patients become part of the fabric of physician assistants, one oncology nurse Patients can also self-refer to meet with the
our center,” explains Mary Keating, director of navigator, one licensed social worker, three social worker and financial counselors.
marketing. financial counselors, one registered dietitian, Portneuf Cancer Center has received the
Housed within the cancer center is an and two certified tumor registrars. All of the American Society of Clinical Oncology’s
infusion suite, clinic, and radiation suite all center’s medical oncology providers and staff Quality Oncology Practice Initiative
on one floor with patient flow in mind. The are hospital employed; radiation oncologists certification.
infusion suite, located at the north end of the are contracted.
cancer center, includes 10 infusion chairs Outreach Clinics
Most patients are referred to the cancer
that look out onto the Portneuf Valley Like other healthcare providers serving a
center by Portneuf Medical Center’s surgeons
through floor-to-ceiling windows and 2 or primary care physicians, which streamlines large rural area, Portneuf Cancer Center’s
private infusion rooms with a hospital bed the referral process. The cancer center also delivery of patient-centered care can be
and private bedroom. The infusion suite is sees patients referred from outside of the affected by its patients’ geographic location,
staffed by 6 nurses—4 full-time, 1 part-time, Pocatello area. ability to travel, and weather conditions. In
and 1 as needed (PRN). Three of the nursing The leading cancer sites treated at response to the needs of patients living in
staff hold oncology-certified nursing Portneuf Cancer Center include breast, lung, rural settings and to reduce the travel burden
credentials and two others have Vascular colorectal, and prostate. Patients with breast for these patients and their families, Portneuf
Access Board certification. The outpatient cancer may be seen at the cancer center’s Cancer Center has opened four satellite
14 accc-cancer.org | March–April 2020 | OIcancer clinics. Farthest from main clinic in hospital runs a free shuttle for travel to the
Pocatello is the clinic at Steele Memorial cancer center from either the guest house
Hospital in Salmon, Idaho (about 210 miles or RV park; valet service is available for
away); the closest satellite clinic is located at those who drive.
Caribou Memorial Hospital in Soda Springs,
Idaho (about 56 miles away). These clinics are Access to Cutting-Edge
staffed daily with licensed practice nurses, a Treatment and Clinical Trials
certified medial assistant, and a physician For patients who need treatment beyond
assistant. A medical oncologist from Portneuf Cancer Center’s capacity or access
Portneuf Cancer Center visits the clinics once to clinical trials, the cancer center
a month, spending two days each in Soda facilitates referrals to the Huntsman Cancer thoracic tumor board is attended by
Springs and Salmon and a full or half-day at Institute in Salt Lake City, Utah. Portneuf cardiologists, pulmonologists, and cardio-
the remaining two satellite sites. Depending Cancer Center has established a streamlined thoracic surgeons.
on the clinic location, oncologists will see referral process with the institute and Because the Portneuf Medical Center and
between 6 to 20 patients face-to-face. coordination is prioritized by both programs. the cancer center’s staff are a close, tight-knit
Chemotherapy, which is overseen by a This referral pathway creates greater group, they are in conversation with one
medical oncologist, is available at each clinic. opportunities for Portneuf Cancer Center’s another frequently to discuss patients’
Should a patient need to be seen by the rural patient population, especially those treatment. “They do not hesitate to pick up
oncologist other than during a scheduled with more complex or rare diseases, to access the phone to call whichever discipline they
visit, the physician assistant or certified specialist care and clinical trials. need to talk to regarding the patient,”
medical assistant at the clinic uses telehealth explains Jenni Adams, RN, BSN, OCN, cancer
so that patients can be seen by their center director. Therefore, tumor boards are
Patient-Centered Care
oncology provider. The Portneuf Cancer not the only place in which multidisciplinary
Portneuf Cancer Center sees a variety of
Center oncologists see about 15 to 20 cancer care is prioritized, because collabora-
patients and prioritizes their care in many
patients a month via telehealth appoint- tion among clinicians and staff takes place
ways. Because it is located next the Fort Hall
ments. The cancer center has seen tremen- every day.
Reservation, its staff works closely with
dous growth in its patient population with Portneuf Cancer Center is proud to have its
the Shoshone-Bannock Tribes. A social clinicians and staff working side by side every
the implementation of these outreach clinics
worker/navigator helps Fort Hall Reservation day. In fact, this close, collaborative environ-
because they enable patients to stay in their
hometowns with their families. If patients patients navigate and coordinate care with ment may be an advantage of caring for
need radiation or combination therapy, they Portneuf Cancer Center. About 10 to 20 patients in its rural setting—the cancer center
are treated at the cancer center in Pocatello. percent of the cancer center’s patient has not experienced high turnover rates
Patients who must travel to the main facility population travels from Fort Hall. among its nurses, therapists, and/or
can take advantage of the resources available There are cultural considerations in providers. “This is a big advantage to
at the Portneuf Medical Center to help them treating this specific patient population, and patient-centered care,” explains Robb Dye,
with the financial burden of treatment and the center’s staff takes pride in its ability to MSW, licensed clinical social worker. “It is all
travel. effectively coordinate and care for these behind the scenes.” This approach has helped
patients. To further accommodate its diverse establish crucial relationships among its staff
Transportation and Lodging patients, staff members—a medical oncolo- and clinicians that patients experience and
gist and social worker—speak fluent Spanish benefit from firsthand. These care providers
Support
or can help translate for its Spanish-speaking know their patients’ names and stories, and
Portneuf Medical Center has a guest house
patients, helping to eliminate cultural and patients are greeted by the same smiling face
and RV park on its campus to accommodate
language barriers to care. at every cancer center visit.
visiting patients, their families, and visitors
To further its patient-centered focus,
who travel long distances or who may
Portneuf Cancer Center holds three tumor
experience weather disruptions that could boards—a general tumor board, a breast-
impact treatment schedules. The RV park has Select supportive care
specific tumor board, and a thoracic tumor
six paved, full hookup sites available at no services include:
board—each scheduled once a month. The
cost, situated by picnic tables and majestic • Nutrition services
tumor board brings together Portneuf
mountain views. Cancer center patients are • Financial counseling services
Medical Center’s urologists, surgeons,
given priority and can reserve a spot through • Psychosocial services
radiologists, interventional radiologist,
their nurse navigator or social worker. The • Support groups
pathologists, nursing staff, navigators,
guest house is located just two miles away medical oncology, radiation oncology, and
Approximate number of new analytic
from the main hospital, can house two support staff. Its three breast surgeons cases seen in 2019: 400
families, and is also free of charge. The attend the breast tumor board, while the
OI | March–April 2020 | accc-cancer.org 15You can also read
