SGO Issues Feb. 6, 2020
Article in press: Lessons learned in developing surgical APMs in oncology
Hiring help | Emily K. Hill, MD
DoD Ovarian Cancer Research Program anticipated funding opportunities
Highlights from February 2020 Gynecologic Oncology Reports
Patient webinar: Uterine and Endometrial Cancer 101
According to an article currently in press in Gynecologic Oncology, Society of Gynecologic Oncology Future of Physician Payment Reform Task Force: Lessons learned in developing and implementing surgical alternative payment models, gynecologic oncologists are experimenting with a variety of alternative payment models (APMs). These are interventions that change the financing of health care to incentivize improved clinical outcomes while reducing unnecessary utilization and costs of care. There are many challenges associated with developing and implementing APMs–including stakeholder engagement, attribution, risk adjustment and quality measurement—and the article’s authors drew upon experiences at their own institutions.
With few practices participating in APMs to date, the authors believe it is important for gynecologic oncologists to learn about existing APMs.
“Given the developing shift from volume to value-based care, having an understanding of APMs/bundles [and the impact they have on reimbursement and practice] is critically important,” said David Cohn, MD, from The Ohio State University Comprehensive Cancer Center in Columbus, OH. “Having the ability to lead in this direction rather than to be mandated by an outside entity on how an APM/bundle should look was attractive to our program.”
Dr. Cohn explained that the business decision to participate in a value-based agreement is really an individual one, based on a number of factors.
“For example, what is the need to develop an infrastructure to avoid preventable readmission or emergency department evaluation? What is the potential for upside benefit to the program and, if relevant, what is the risk?” he said. “Doing a pro forma model to determine the potential risk and opportunity is important. However, one must also consider the benefit of becoming operationally comfortable with integrating a value-based agenda into a practice since it is likely that this will be a requirement in the near future. Having a head start in this process was attractive in our equation.”
Task Force member Patrick Timmins, MD, from Women’s Cancer Care Associates in Albany, NY, noted that his practice has been closely following the wave of change from fee-for-service to value-based payment models.
“As a small practice, it is sometimes easier to make these big decisions as a practice,” said Dr. Timmins. “In order to best serve our patients and position ourselves for continued growth it made sense for us to try and stay ahead of the curve.”
Dr. Timmins added that the Oncology Care Model (OCM) was the best fit for his practice and specialty. Developed by the Center for Medicare and Medicaid Innovation (CMMI), the goal of the OCM is to improve care coordination, appropriateness, and access for beneficiaries undergoing chemotherapy, while reducing total costs.
“In participating with the OCM, we have received tremendous support from CMMI as well as other organizations such as Community Oncology Alliance,” said Dr. Timmins. “The resources and opportunities to collaborate with colleagues would not have been possible for us independent from the APM. The OCM gives us a framework and jumping off point to modify our practices in different areas of patient care and operations.”
Both Dr. Cohn and Dr. Timmins have advice for other practices that are considering entering into an APM.
Dr. Timmins had three specific pieces of advice on developing and implementing an APM for the gynecologic oncology subspecialty:
- Do your research. Review the APMs available to your organization including the structure of the model, requirements, and benefits.
- Get all providers on board. Most APMs require a culture change within the practice in order to achieve the goals of the model. It is very difficult to succeed without physician buy-in across the organization.
- Check your EMR for compatibility with the model. Most APMs will require some EMR modifications. It is so much easier when your EMR vendor is aware of the model and already has certain things in place to address the requirements of the model.
“While it was tempting to stay on the sidelines and wait for a mandate or a general bundle that was created outside of our institution, we believed that getting a first-hand knowledge of the creation of a bundle was important enough,” said Dr. Cohn. “As we started this work, our hospital team has continued to create more complex bundles that has allowed us to gain additional experience with payors. If in the future bundles are presented to us for participation, we have a head start in understanding how they work in our system.”
Payment reform will be the topic of Education Forum IX: Show Me the Money! Payment Reform in Gynecologic Oncology on Monday, March 30 at 5:00 p.m. – 6:00 p.m. during the SGO 2020 Annual Meeting on Women’s Cancer in Toronto.
“I’d pay someone to wipe my ass if I could.” This is a quote loosely attributed to one of our fellow gyn oncologists. I wasn’t there when she said it, but it was recounted to me and stemmed from a lecture about work-life balance way before that topic was en vogue. When I was pondering what to write about for this blog, my husband reminded me of this quote. Sure, some could interpret it as “elitist” or “privileged,” but to me it has always struck a chord and felt like a healthy dose of reality from a working mom.
We all know that gyn oncologists work extremely hard and have invested a fortune training to do our job. Many of us are also parents, have working spouses, take care of our own parents–the list goes on and on. With that in mind, we have to think of our time as expensive and a scarce commodity. It’s not that we are “too good” to do the everyday things in life like cleaning, cooking or childcare, but that we simply cannot do it all. We need help and we should not be ashamed to ask for it, and in fact, to pay for that help. You should be practicing at the top of your license, and for us, that does not include cleaning toilets (unless you like that kind of thing).
My mom is a retired librarian who had reasonable 8:00 a.m. to 5:00 p.m. hours and did not usually work weekends. She told me that the one thing she wished she had done when my brother and I were growing up was to hire a house cleaner. We spent every Saturday cleaning–each of us dividing and conquering toilets, dirty floors and laundry. She, in retrospect, resented all the time we spent cleaning when we could have been doing more fun or fulfilling things together. We did learn about hard work and responsibility, but we also missed out on family time and it added stress to my mom’s life.
Since I routinely leave before my kids get up, come home after they are asleep, miss school drop-offs and pick-ups, and barely make it to important events in their lives, I’ll be damned if I am going to spend my whole Saturday cleaning the house. My husband and I will continue to do reasonable household chores and hopefully teach our kids in the process, but as for time-consuming semimonthly cleaning, I have paid someone for that service since fellowship and have zero regrets about it. We do cook, but sometimes pay someone to cook for us. We have hired amazing nannies, so that while a parent is not always there, our children have support and consistent caretakers.
I should farm out even more tasks–such as yard care, snow shoveling, grocery shopping–and if I ever find time to arrange those services, I’m sure it will be well worth it. I do not think we should feel guilty or apologize; delegating is just a reality of what is needed to make the work of gyn oncology sustainable.
So if you hear of someone advertising that they wipe asses for a small fee, can you send them my way?
Emily K. Hill, MD, is a Clinical Assistant Professor at the University of Iowa Hospitals and Clinics Division of Gynecologic Oncology in Iowa City, IA.
The Fiscal Year 2020 (FY20) Defense Appropriations Act is anticipated to provide funding to the Department of Defense (DoD) Ovarian Cancer Research Program (OCRP) to support patient-centered research to prevent, detect, treat, and cure ovarian cancer to enhance the health and well-being of service members, veterans, retirees, their family members, and all women impacted by this disease. The FY20 Defense Appropriations Bill has not been signed into law yet, but the OCRP is providing the following information in a pre-announcement to allow investigators time to plan and develop ideas for submission to the anticipated FY20 funding opportunities.
Subject to the FY20 Congressional appropriation for OCRP funding, FY20 OCRP Program Announcements and General Application Instructions for the following award mechanisms will be posted on the Grants.gov website. Pre-application and application deadlines will be available when the Program Announcements are released.
- Clinical Translational Award supports translational research addressing high-impact or unmet needs in ovarian cancer (maximum funding of $450,000 over three years).
- Investigator-Initiated Research Award supports meritorious basic and clinically oriented research in ovarian cancer (maximum funding of $500,000 over four years).
- Ovarian Cancer Academy Award – Early-Career Investigator supports the addition of new Early-Career Investigators (ECIs) to the unique, interactive virtual academy that provides intensive mentoring, national networking, collaborations, and a peer group for junior faculty. Pre-application is required; application is by invitation only. Maximum funding of $725,000 over four years, with a fifth-year option.
- Pilot Award supports innovative, high-risk/high-reward research that could ultimately lead to critical discoveries or major advancements that will drive the field of ovarian cancer research forward (maximum funding of $250,000 over two years).
- Teal Expansion Award supports the expansion of the initial research idea or the generation of a new idea based on the original research project. Pre-application is required; application submission is by invitation only. Maximum funding of $450,000 for up to three
For email notification when Program Announcements are released, subscribe to program-specific news and updates under “Email Subscriptions” on the eBRAP homepage at eBRAP.org. For more information about the OCRP or other CDMRP-administered programs, please visit the CDMRP website.
Widespread choriocarcinoma metastases from de-differentiated gastro-esophageal junction primary adenocarcinoma: A case report with literature review
Evan Schrader, Amanda J. Stephens, Seema Shroff, Sarfraz Ahmad, Robert W. Holloway
Invasive endometrial adenocarcinoma and missed abortion: A case report
Nicole B. Gaulin, Lakshmi Harinath, Sharon Liang, Thomas C. Krivak, Eirwen M. Miller
Invite your patients and their families or caregivers to join this free webinar on Monday, March 16, at 2:00 p.m. – 3:00 p.m. CT to gain a deeper understanding of uterine and endometrial cancer symptoms, diagnosis, treatment options and current research trends with Jason D. Wright, MD, Division Chief of Gynecologic Oncology at New York-Presbyterian/Columbia University Medical Center. This webinar is a collaboration between SHARE and the Foundation for Women’s Cancer. Help spread the word by printing and hanging a promotional poster in your office or institution.