2016 Public Report of Outcomes
HSHS St. Vincent Hospital Regional Cancer Center is committed to sharing outcomes of our efforts to continuously evaluate and improve the quality of care we provide. Through feedback from patients, our own observations, national and local trends and other sources, we continuously seek to identify ways in which we can improve our care.
We are pleased to report that HSHS St. Vincent Hospital Regional Cancer Center was reaccredited as an Integrated Network Cancer Program in 2015 for a three-year term, with commendation in all applicable standards.
As a result of this excellent program performance, we were also awarded the Commission on Cancer’s Outstanding Achievement Award in 2015. This award recognizes cancer programs that strive for excellence in demonstrating compliance with the Commission on Cancer standards and are committed to ensuring high quality cancer care.
The cancer program at HSHS St. Vincent Hospital Regional Cancer Center provides a broad scope of services, from cancer prevention outreach and education to cancer detection, treatment, palliative care and survivorship. Our program receives guidance and leadership from the Department of Oncology and Cancer Committee, which convenes regularly to ensure that we are meeting the standards outlined by the American College of Surgeons Commission on Cancer. These standards address education, treatment, clinical research, data collection, performance and quality improvement initiatives.
At HSHS St. Vincent Hospital Regional Cancer we are committed to the design and implementation of quality patient care and treatment services. In this report we will highlight two quality improvement initiatives implemented in 2016:
1.Improve access and integration of behavioral health services within the Regional Cancer Center.
Provide HSHS St. Vincent Hospital Regional Cancer Center patients with a greater opportunity to access behavioral health services particularly at the St. Vincent and St. Mary’s cancer center sites.
Background and Rationale:
In 2015, the Cancer Committee completed a study to identify the behavioral health needs of cancer patients and develop recommendations for how to improve them. The results of that study showed that approximately 200-300 patients receiving care in the Green Bay Cancer Center locations could qualify for behavioral care services. To improve the referral process for oncology clinicians and track outcomes, an oncology- specific behavioral medicine referral order was implemented within the electronic medical record (EMR); however, the referral order was minimally accessed by oncology clinicians throughout 2015.
Outcomes of Quality Improvement Effort:
- Identify a select group of behavioral health clinicians to provide support to cancer patients.
- Orient this cohort of clinicians to the needs of cancer patients/survivors by providing more than 25 hours of cancer and survivorship continuing education.
- Work collaboratively with Prevea Health to hire a psychologist who can service this population of patients.
- Establish order sets in the electronic medical record so that oncology clinicians can refer directly to a cancer-specialized clinician in the Prevea Behavioral Health department.
- Work collaboratively with Prevea Behavioral Health to establish procedures and processes for referrals and service provision of these patients.
- Establish a reporting process to track referrals and consults.
Throughout 2016 the presence and access to behavioral medicine has increased for HSHS St. Vincent Hospital Regional Cancer Center patients, with the hope of improving coping abilities and decreasing stress in a tumultuous time.
Three additional Prevea Health behavioral medicine therapists completed more than 25 hours of cancer and survivorship-based continuing education. As a result, we now have a total of five cancer-specific therapists accessible in the Green Bay area. This has increased patient access to behavioral medicine support in the Green Bay area and our regional locations.
A cancer center team worked closely with Prevea Health as they recruited and employed an on-site psychologist, allowing immediate access for crisis patients both receiving outpatient and inpatient cancer care. Since July 2016, psychology services have been provided daily at both HSHS St. Vincent Hospital and St. Mary’s Hospital Medical Center. In addition, this clinician has completed cancer and survivorship training. Through personal introductions and communications, the availability of this additional resource has become integral to the oncology team.
In 2016, 43 patient referral orders for oncology behavioral medicine were ordered in Epic (an EMR program). In addition, another 27 referral orders were placed through the medical oncology EMR – Mosaic, for a total of 70 patients referred to oncology behavioral medicine. This increase indicates a greater understanding by clinicians of the increased availability of cancer-specific behavioral health resources and a willingness to offer these resources to patients who can benefit.
The conversion of referrals to appointment completion remains an area of focus for the future. Of the 43 orders placed in Epic for behavioral medicine; three did not convert to an appointment or phone call, 15 patients refused to schedule an appointment, and 25 patients scheduled and attended an appointment with a behavioral health provider. This resulted in a conversion rate of 58%. Due to differences in EMR systems, the other 27 referrals could not be assessed.
Further Improvement Opportunities:
The cancer team will continue to work on identifying the barriers that impact the number of individuals who utilize this resource. In June of 2017, all cancer center providers will be converting to the same EMR. It is expected this will improve communication between providers and increase efficiency in tracking the course of our patients. The ultimate goal is to continue to improve access to behavioral health services and support for our cancer patients.
2.Expand financial counseling services to serve all Regional Cancer Center patients.
Provide all cancer patients with the opportunity to meet with a financial counselor to evaluate insurance coverage and financial impact of cancer services.
Background and Rationale:
Given the complexities of health insurance coverage and the U.S. healthcare system, as well as the cost of cancer care, many patients are overwhelmed at the thought of managing the financial aspects of their cancer treatment. According to a study by the Advisory Board (2014), the cost of cancer as a percentage of average household income is as high as 49%. Additionally, the report noted that 32% of cancer patients report cancer-related financial problems and 23% percent of cancer patients reported that they postponed recommended health care due to cost. The HSHS St. Vincent Hospital Regional Cancer Center’s cancer committee also completed a patient survey in 2015 to assess cancer survivors’ needs. That survey revealed that financial concerns were one of the top social issues for our survivors. Increasingly, the oncology community has referred to this as the “financial toxicity” of cancer care. As with any side effect of care, we have an obligation to help our patients deal with these concerns.
The medical oncology department of HSHS St. Vincent Hospital Regional Cancer Center has had financial counselors available to assist patients for many years at all locations, as well as for radiation oncology patients at the St. Mary’s Hospital location. These counselors met with patients if they had questions, but did not consistently meet with every patient at the inception of their treatment and did not provide a prospective financial summary of benefits.
The cancer center leadership team recommended expanding the role of the financial counselor to other radiation oncology locations, as well as to GYN oncology and pediatric oncology. In addition, a benefit summary document was recommended for the purpose of reviewing insurance coverage and providing patients with information about their personal financial responsibility.
Outcomes of Quality Improvement Effort:
- Establish a plan for implementing financial counseling services throughout the cancer program at HSHS St. Vincent Hospital Regional Cancer Center.
- Develop a staffing plan for the expanded services.
- Develop operational processes for the use of a benefit summary form
- Determine office space for financial counselors in the radiation oncology and GYN oncology departments.
In June, 2016 a financial counselor began seeing patients in the radiation oncology departments at the St. Vincent Hospital and Door County Cancer Center locations (in addition to continuing to meet with patients at the St. Mary’s location). The counselor meets with every new radiation oncology patient at the inception of their care. During this meeting, the counselor reviews the patient’s health benefits and completes a summary of benefits form which includes the patient’s deductible status, co-pay responsibilities and maximum out of pocket costs. This gives the patient and their families a better understanding of how their cancer treatment will impact their financial well-being.
- Benefit summaries provided to new radiation patients at the St. Vincent’s and Door County sites from June – mid-November, 2016 = 94
- Benefit summaries given to new radiation patients at the St. Mary’s site from June – mid-November, 2016 = 40
Additionally, this service was implemented in the pediatric oncology clinic in September 2016 and the gynecologic oncology clinic in November 2016.
The feedback from patients about the benefit summaries has been very positive. In 2017, a random sampling of patients who have received this service will be surveyed. Based on the survey results, the team will determine if they will expand the use of the benefit summary to other areas within the cancer center.