SGO Issues Feb. 11, 2016
Health Policy and Socioeconomic Task Forces: Year One accomplishments
Palliative care in cervical cancer, part II | Lois Ramondetta, MD
Research grant awards presented at Annual Meeting
Choosing Wisely survey to determine practice-changing impact
2016 SGO Board Election ends Feb. 12
By Laurel W. Rice, MD
I cannot begin to thank the members of the SGO Health Policy and Socioeconomic Committee for their commitment to their respective task forces this past year. With the new year underway, and my term as committee chair coming to an end in March, I’ve taken some time to reflect on all the work that has been done. Together, in less than one year, our task forces have served the SGO extremely well, and by doing so, have helped women with and at risk for gynecologic cancers.
Our task force members have made progress in the following areas of health policy over the past year:
Policy, Quality and Outcomes Task Force:
- Fifteen quality measures were submitted to the Physician Quality Reporting System (PQRS) in June and nine are currently under consideration for inclusion in 2017 reporting programs.
- Three measures are being prepared to submit to the National Quality Forum (NQF) by the end of May. An audit function was added to the SGO Clinical Outcomes Registry to test evidence.
- The task force continues to review proposals from the Centers for Medicare and Medicaid Systems regarding the implementation of the Medicare Access and Chip Reauthorization Act (MACRA) of 2015 and provide comment on programs that arise, specifically the Merit Incentive Payment System (MIPS) which will replace PQRS, VBPM and Meaningful Use.
Legislative and Regulatory Affairs Task Force:
- More than 100 SGO Members were recruited for the SGO Congressional Ambassadors Program to conduct grassroots outreach. The Ambassadors contacted their state representatives on the House and Senate Appropriations committees to ensure that ovarian cancer research received $20 million from the Department of Defense budget in 2016.
- This task force has been laying the groundwork to make a case to increase federal support of clinical trials in gynecologic oncology and address the affordability of cancer drugs. Position statements are drafted and under review. SGO met with leaders of the National Cancer Institute on Feb. 1.
The Future of Physician Payment Reform Task Force:
- The group is working to build a framework for endometrial cancer patients and analyze Market Scan and Medicare data to develop a bundled payment model.
- They have also reviewed proposals from CMS and provided comment regarding alternative payment models.
- SGO is participating in a working group with other medical societies regarding Alternative Payment Models.
- A Special Interest Session will be offered at the Annual Meeting on the Future of Physician Payment to educate attendees on alternative payment models.
Coding and Reimbursement Task Force:
- This group has provided member education on the ICD-10 transition and continually answers individual questions from members and their coding staff sent to email@example.com.
- They attempted to recover RVU reductions to laparoscopic hysterectomy codes by gathering data and meeting with ACOG and CMS.
- They are currently working on two new CPT codes to address reimbursement for the following:
–Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), single or multiple, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, with omentectomy
–Laparoscopy, surgical, total hysterectomy; with or without salpingo-oophorectomy, unilateral or bilateral, with resection of malignancy (tumor debulking), with omentectomy
Looking back, I am so grateful for the work these task forces have accomplished, all on a volunteer basis, with remarkable enthusiasm. True commitment and generosity of spirit! The mission of the SGO will continue to be first and foremost with members such as these doing the heavy lifting. I am looking forward to continuing our work together in 2016.
Laurel W. Rice, MD
Chair, SGO Health Policy and Socioeconomic Committee
SGO President Elect II
The discussion of futility is not new to cervical cancer or to gynecologic oncology, but that doesn’t make it any easier. The goal, in a terminal setting, is always to extend life but not if it means compromising quality of life (QOL). Who is to say that one week more of life–in any condition–is not “quality” to someone else?
Ideally, quality would be improved with any treatment. I look forward to the day we can design clinical trial end points accordingly. For many of the women we treat with palliative intent, I struggle most with how honest we have been, and whether we have truly treated them in their best interests. Furthermore, I have asked myself what I would do in a similar setting, with such limited time, if I were that patient.
Many of our colleagues have casually responded that they would not get chemo in this setting, suggesting that instead they would go to a beautiful island to bask in the sun or to travel to an exotic land. I wonder if we give others that same opportunity. In other words, when the consent for the palliative chemotherapy is signed, were we sure to include, in our “presentation,” the percentage of time that no response is seen (not the percentage of time that a response is seen) and the option to do only supportive care because the outcome may not be any worse? Have we told our patients that now is the time to make amends with family and friends, or asked them if they want to travel anywhere (if the opportunity exists), or warned them that the time may come soon when they are unable to travel?
Finding the right balance is hard. Patients do not always welcome the “facts.” Satisfaction between patients and physicians may even diminish in a setting when incurable disease is emphasized. Recently, as an American Society of Clinical Oncology quality of care measure, we as providers were asked to ensure that our Electronic Medical Records (EMR) progress notes included a statement with the patient’s stage, goal of treatment, and expected prognosis with the obvious assumption that we have discussed this information with the patient. I’m curious if this new measure will cause us to have more practical conversations with patients, and if we as a society are moving towards this practical response to treatment decisions.
For many cervical cancer patients, the complexities of the health care system are intimately intertwined with issues related to resource allocation, appropriate screening tests, missed vaccinations, access to care and health literacy, school-based health education, out-of-pocket costs, and self-efficacy.
In my opinion, gynecologic oncologists have several ways to approach the conundrum of deciding what is best for patients with advanced or recurrent cancer.
- Incorporate a symptom assessment into every patient encounter and address or triage all clinically significant areas of distress. Refer all women with incurable disease to supportive care specialists early in the course of recurrence work up.
- Design tools that take end-of-life (EOL) decision making to the next (existential) level. Ask real questions. Not just Advanced Directive, Do Not Resuscitate and Power of Attorney questions, but something more along the line of the five wishes document approved in certain states.
- Remember that informed consent includes the option to forgo treatment and that our presentation of options often guides decisions for patients. In order to present non-biased information we must first be comfortable with our own choices. I often think this means having time to reflect on what our own life choices might be in these situations and to be comfortable with our answers and recognize our biases.
- Lead the way in designing clinical trials that take into account the improvement of symptoms as well as decreased size of the tumor, trials with dual end points, or trials valuing aspects of QOL as much as relative risk. For example, an end point aimed at decreasing the size of the tumor and reducing side effects.
- Recognize the important role we play in raising awareness of the importance of vaccinating all girls and boys before age 13 against HPV.
Deaths due to cervical cancer are so much more tragic because we have everything we need to eliminate this disease (in a perfect world), and we can no longer stand to see women die from a cancer that could have been prevented.
Lois M. Ramondetta, MD, is a Professor in the Department of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center, Houston, TX, and Chief, Division of Gynecologic Oncology, Lyndon B. Johnson General Hospital, Harris Health System, Houston, TX. Read part I of her blog post on palliative care in cervical cancer from the Jan. 28 SGO Issues.
The Foundation for Women’s Cancer announces the recipients of six research grant awards originated by the Foundation for Gynecologic Oncology. The awards will be presented at the 2016 SGO Annual Meeting on Women’s Cancer in San Diego, CA, on Sunday, March 20, at the start of Scientific Plenary IV: Genetic Risk Assessment.
SGO is asking members to respond to a survey with a few brief questions about their awareness of SGO’s Choosing Wisely recommendations and any practice changes that they may have implemented as a result. The survey and its data will be shared with referring providers to ensure that members are offering coordinated care and educational outreach for their patients.
In 2013, SGO joined the ABIM Foundation’s Choosing Wisely campaign, which asked medical societies to list their specialties’ top five overused tests or procedures. With additional materials available through Consumer Reports, Choosing Wisely helps patients avoid unnecessary medical care. Members are being asked to fill out the survey prior to opening of the Annual Meeting on Saturday, March 19.
Voting for the 2016 SGO Board Election ends on Friday, Feb. 12, at 11:59 p.m. CST. All eligible voting members should have received an email from firstname.lastname@example.org on Jan. 11 with a link to the online ballot. The list of candidates for each position, including biographical information, personal statements and photos, as well as answers to frequently asked questions are on the SGO website.