scholarly journals Prior Authorization for Medications in a Breast Oncology Practice: Navigation of a Complex Process

2017 ◽  
Vol 13 (4) ◽  
pp. e273-e282 ◽  
Author(s):  
Ankit Agarwal ◽  
Rachel A. Freedman ◽  
Felicia Goicuria ◽  
Catherine Rhinehart ◽  
Kathleen Murphy ◽  
...  
Keyword(s):  
Care Delivery ◽  
High Volume ◽  
Cancer Center ◽  
Prior Authorization ◽  
Patient Demographics ◽  
Approval Rate ◽  
Decision Points ◽  
Oncology Practice ◽  
The Cost ◽  
The Impact

Introduction: The cost and burden associated with prior authorization (PA) for specialty medications are concerns for oncologists, but the impact of the PA process on care delivery has not been well described. We examined PA processes and approval patterns within a high-volume breast oncology clinic at a major academic cancer center. Methods: We met with institutional staff to create a PA workflow and process map. We then abstracted pharmacy and medical records for all patients with breast cancer (N = 279) treated at our institution who required a PA between May and November 2015 (324 prescriptions). We examined PA approval rates, time to approval, and associations of these outcomes with the type of medication being prescribed, patient demographics, and method of PA. Results: Seventeen possible process steps and 10 decision points were required for patients to obtain medications requiring a PA. Of the 324 PAs tracked, 316 (97.5%) were approved on the first PA request after an average time of 0.82 days (range, 0 to 14 days). Approximately half of PAs were for either palbociclib (26.5%) or pegfilgrastim (22.2%), and 13.6% of PAs were for generic hormonal therapy. Requirements to fax PA requests were associated with greater delay in approval time (1.31 v 0.17 days for online requests; P < .001). The use of specialty pharmacies increased staff burden and delays in medication receipt. Conclusion: The PA process is complicated and labor intensive. Given the high PA approval rate, it is unlikely that PA requirements reduce medication utilization in practice, and these requirements may impose unnecessary burdens on patient care. The goals and requirements for PAs should be readdressed.

scholarly journals Examining Telephone Calls in Ambulatory Oncology

2009 ◽  
Vol 5 (2) ◽  
pp. 57-60 ◽  
Author(s):  
Marie Flannery ◽  
Shannon M. Phillips ◽  
Catherine A. Lyons
Keyword(s):  
High Volume ◽  
Telephone Call ◽  
Practice Characteristics ◽  
Ambulatory Oncology ◽  
Specific Practice ◽  
Telephone Calls ◽  
Oncology Practice ◽  
Outpatient Appointments ◽  
The Impact ◽  
Call Volume

Purpose: A large component of ambulatory oncology practice is management of telephone calls placed to and from the practice between outpatient appointments. However, scant information is available in the literature concerning oncology practice telephone calls. The specific aims of this study were to define telephone call volume and distribution in an active ambulatory oncology practice, describe the callers and reasons for the telephone calls, and examine any differences in call volume by practice characteristics. Methods: A descriptive retrospective design was used to analyze medical oncology and hematology telephone calls in a 4-month period. Two investigator-developed tools were validated and used to collect data on telephone call content and patient demographics. Results: The sample included 5,283 telephone calls to or from 1,486 different individuals. Individuals making and/or receiving more than one telephone call in the study period represented 56% of the telephone calls. For every 10 scheduled clinic appointments, seven telephone calls were received or made. The volume of telephone calls was significantly higher on Mondays and in the mornings. The reasons for high-volume telephone calls by diagnosis and frequency were identified, with 30% of telephone calls involving multiple reasons. Conclusion: The data demonstrate the impact of telephone calls on ambulatory oncology practice and highlight the complex and highly variable actions required to manage the telephone calls. The findings confirm and document specific practice patterns and identify subgroups that target repeat telephone calls as an area for improvement.

Use of nonclinical staff to coordinate oral anticancer drug prescriptions.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 72-72
Author(s):  
Daniel O'Neil ◽  
Melissa Kate Accordino ◽  
Jason Dennis Wright ◽  
Cynthia Law ◽  
Suzuka Nitta ◽  
...  
Keyword(s):  
Linear Regression ◽  
Anticancer Drug ◽  
Wholesale Price ◽  
Drug Approval ◽  
Financial Assistance ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Off Label ◽  
Oncology Practice ◽  
The Impact

72 Background: In September 2018, Herbert Irving Comprehensive Cancer Center (HICCC) began using non-clinical pharmacy liaisons to oversee coordination of oral anticancer drug (OACD) prescriptions (RXs), a task previously performed by clinical staff. Liaisons interact with payers, specialty pharmacies and financial assistance (FA) groups. We assessed the impact of this strategy on time to receipt of OACDs. Methods: We collected prospective data on all new OACD RXs from HICCC’s medical oncology practice from 1/1/2018 to 9/17/2018 (pre-liaisons) and 9/17/2018 to 5/1/2019 (post-liaisons). We collected patient demographic and insurance data; date of prescription; date of drug delivery; and interactions with payers and FA groups. Federal Drug Association labels were reviewed for drug approval dates and indications. Daily drug cost was defined according to average wholesale price. We define time to receipt (TTR) as days from RX to OACD delivery and used multivariable linear regression to determine factors associated with TTR (log transformed). Results: Over the study period, we evaluated 707 RXs; 93 (13%) were never filled. Of 614 filled RXs, 350 (57%) were placed in the pre-liaison period and 264 (43%) in the post-liaison period. After introduction of liaisons, FA was pursued for more RXs (17% vs 25%, p = 0.007); there was no difference pre- and post-liaisons in patient demographics, distribution of payers, RXs needing prior authorization (PA) (76% vs 77%), off-label RXs (14% vs 16%), RXs for drugs approved < 2 years earlier (5% vs 3%) or mean daily cost ($471 vs $470). Mean TTR before and after liaisons were 11.9 and 11.6 days, respectively. Linear regression showed longer TTR was associated with commercial payers (p = 0.02), need for PA (p = 0.03), FA pursuit (p ≤ 0.0001) and daily OACD cost (p = 0.03); no association was seen with use of liaisons, patient age, off-label use or OACDs approved < 2 years earlier. Conclusions: Implementation of pharmacy liaisons to coordinate OACD prescriptions did not impact the time to OACD receipt, though liaisons were able to pursue financial assistance for more patients. Insurance and cost factors had the greatest impact on time to drug receipt. Task shifting may reduce the clerical workload for providers.

scholarly journals Dwelling Time pada Sistem dan Prosedur Penanganan Peti Kemas dengan Aplikasi Cost Terminal Operation System di Terminal Peti Kemas Semarang

2021 ◽  
Vol 2 (1) ◽  
pp. 49-55
Author(s):  
Riyanto ◽  
R.A.J Susilo Hadi Wibowo ◽  
Fajar Transelasi ◽  
Dewi Kartika Sari
Keyword(s):  
System Application ◽  
Container Terminal ◽  
Weather Conditions ◽  
High Volume ◽  
Import Demand ◽  
Operation System ◽  
Dwelling Time ◽  
Container Handling ◽  
The Cost ◽  
The Impact

The performance system at the container terminal at Semarang Container Terminal (SCT) is not yet good, it can be seen from the average dwelling time which is still long. Dwelling time optimization needs to be done in order to get a balance of projected increases during trading and to compensate for the various limitations of terminal facilities and infrastructure. One of them is the container handling procedure using an application, namely the cost terminal operating system application. With the qualitative descriptive method, the dwelling time and container handling procedures will be explained using a cost terminal operation system application and the quantitative method is used to find out how much use is in the presence of a vehicle terminal using the formula. There is a very significant positive effect of dwelling time on Port revenue. The long dwelling time is due to several factors, such as high volume / import demand which causes queues during the inspection procedure, 24-hour system inability to perform inspection procedures, weather conditions, and importer readiness. By implementing this system there will be an acceleration of the dwelling time so that Beneficial to importers and the impact caused by container dwelling time after using the cost terminal operation system application is that the waiting time can be reduced.

scholarly journals Do Patients and Oncologists Discuss the Cost of Cancer Treatment? An Observational Study of Clinical Interactions Between African American Patients and Their Oncologists

2017 ◽  
Vol 13 (3) ◽  
pp. e249-e258 ◽  
Author(s):  
Lauren M. Hamel ◽  
Louis A. Penner ◽  
Susan Eggly ◽  
Robert Chapman ◽  
Justin F. Klamerus ◽  
...  
Keyword(s):  
Social Support ◽  
African American ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Financial Toxicity ◽  
Younger Patients ◽  
Patients With Cancer ◽  
The Cost ◽  
Clinical Interactions ◽  
The Impact

Purpose: Financial toxicity negatively affects patients with cancer, especially racial/ethnic minorities. Patient-oncologist discussions about treatment-related costs may reduce financial toxicity by factoring costs into treatment decisions. This study investigated the frequency and nature of cost discussions during clinical interactions between African American patients and oncologists and examined whether cost discussions were affected by patient sociodemographic characteristics and social support, a known buffer to perceived financial stress. Methods Video recorded patient-oncologist clinical interactions (n = 103) from outpatient clinics of two urban cancer hospitals (including a National Cancer Institute–designated comprehensive cancer center) were analyzed. Coders studied the videos for the presence and duration of cost discussions and then determined the initiator, topic, oncologist response to the patient’s concerns, and the patient’s reaction to the oncologist’s response. Results: Cost discussions occurred in 45% of clinical interactions. Patients initiated 63% of discussions; oncologists initiated 36%. The most frequent topics were concern about time off from work for treatment (initiated by patients) and insurance (initiated by oncologists). Younger patients and patients with more perceived social support satisfaction were more likely to discuss cost. Patient age interacted with amount of social support to affect frequency of cost discussions within interactions. Younger patients with more social support had more cost discussions; older patients with more social support had fewer cost discussions. Conclusion: Cost discussions occurred in fewer than one half of the interactions and most commonly focused on the impact of the diagnosis on patients’ opportunity costs rather than treatment costs. Implications for ASCO’s Value Framework and design of interventions to improve cost discussions are discussed.

scholarly journals The Impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume Cancer Center

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Benjamin D. Powers ◽  
William Fulp ◽  
Amina Dhahri ◽  
Danielle K. DePeralta ◽  
Takuya Ogami ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Pancreatic Adenocarcinoma ◽  
High Volume ◽  
Socioeconomic Deprivation ◽  
Cancer Center ◽  
The Impact

Cost Analysis of TSV Process and Scaling Options

2014 ◽  
Vol 2014 (1) ◽  
pp. 000001-000007
Author(s):  
Victor Vartanian ◽  
Larry Smith ◽  
Klaus Hummler ◽  
Steve Olson ◽  
Brian Sapp ◽  
...  
Keyword(s):  
High Volume ◽  
Film Structure ◽  
Manufacturing Cost ◽  
Wafer Level ◽  
Factors Affecting ◽  
Multiple Process ◽  
Cost Of Materials ◽  
The Cost ◽  
The Impact ◽  
Cost Differences

SEMATECH evaluated the impact of various process options on the overall manufacturing cost of a TSV module, from TSV lithography and etch through post-plate CMP. The purpose of this work was to understand the cost differences of these options in order to identify opportunities to significantly reduce cost. Included in this study were multiple process and materials options for TSV etch, liner, and barrier/seed (B/S). For each of these options, recipes were adjusted for post-etch clean, ECD Cu fill and CMP overburden, and the resulting cost impacts were evaluated. The TSV dimensions used in this study are 5x50 μm and 2x40 μm. These cost comparisons included a sensitivity analysis, highlighting the main factors responsible for the differences. Cost of materials, tool cost, and throughput were the primary factors affecting cost differences, especially in barrier/seed deposition. In some cases the contributions from both these sources were comparable. We explain the assumptions used and some of the uncertainties inherent in this work. For example, where materials costs were significant, we extrapolated the cost of new materials from research quantities to those needed to support high volume manufacturing. We had to estimate throughputs and materials costs using our best engineering judgment, because the recipes have not yet been optimized. We also considered that the tools used on some non-critical steps might be fully depreciated, or a lower cost tool such as is used in wafer level packaging. Despite these uncertainties and assumptions, we were able to extract some fairly clear conclusions. The process options include the following B/S variations: For 5x50 μm TSVs, the B/S film structure is TaN/Ta/Ru/Cu, and the options are with and without the Ru and/or Cu layers. For 2x40 μm TSVs, the B/S structure is TaN/Ru/Cu, with different thicknesses of Ru, and the Cu is an optional seed layer for the field. We also discuss the impact of scaling the TSV dimensions on manufacturing costs. This work is continuing to look at different process options and to apply this methodology to MEOL modules such as temporary bond and debond, wafer thinning, and TSV reveal.

scholarly journals Effect of Surgical Oncologist Turnover on Hospital Volume and Treatment Outcomes Among Patients With Upper GI Malignancies

2020 ◽  
pp. JOP.19.00761
Author(s):  
Jan Franko ◽  
Daniela Frankova
Keyword(s):  
Care Delivery ◽  
State Level ◽  
Surgical Oncology ◽  
The State ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Control Group ◽  
Index Hospital ◽  
The Impact ◽  
Surgical Oncologist

PURPOSE: Lack of surgical expertise may affect cancer care delivery. Here, we examined the impact of surgical oncologist vacancy and turnover in a community cancer center serving a mixed urban and rural population. METHODS: Survival outcomes of patients with potentially resectable esophageal, gastric, and pancreatic carcinomas treated in the index hospital (n = 519) were compared with those of a then-contemporary control group derived from the state-specific SEER registry (n = 3,340). The onboarding period (ie, the period without a surgical oncologist) and early and late periods with a surgical oncologist were defined. RESULTS: At the state level, there was a steady trend of patients who were annually referred (290.4 ± 34.3 patients per year; P < .001) and underwent operation (158.7 ± 18.7 patients per year; P < .001). We observed the absence of an analogous trend in the index hospital ( P = .141). The index hospital diagnosed 12.2% of state cancers of interest during the years with surgical oncologists but only 6.7% of cancers when surgical oncologists were absent ( P = .031). The survival model adjusted for age, stage, and primary disease site comparing the early and late periods demonstrated that being treated in the index hospital did not result in inferior survival (hazard ratio, 1.067; P = .265). CONCLUSION: Loss of surgical oncologists was associated with referral decline and likely out-migration of patients, whereas prompt restoration of surgical oncology services reinstated volumes and preserved survival outcomes.

scholarly journals Achieving Meaningful Use and Operational Efficiency

2012 ◽  
Vol 8 (2) ◽  
pp. 70-70
Author(s):  
Mithi Govil ◽  
Carla Wood ◽  
Thomas R. Barr
Keyword(s):  
Specific Activity ◽  
Work Group ◽  
Clinical Care ◽  
Meaningful Use ◽  
Operational Efficiency ◽  
Cancer Center ◽  
Incentive Program ◽  
Oncology Practice ◽  
Data Elements ◽  
The Impact

Purpose: The Centers for Medicare and Medicaid Services (CMS), through the Electronic Health Record (EHR) Incentive Program, are providing incentive payments to eligible professionals as they demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 over a 5-year period for Medicare participation if they successfully demonstrate the ability to automatically generate, transmit, and meet thresholds for specific reporting elements from the EHR. Meeting the meaningful use requirement involves a reorganization of workflow within the clinical setting so that the data elements necessary to produce the relevant measurements are documented in the electronic medical record (EMR) as they are delivered. A by-product of this is operational efficiency improvement in three areas: coordination of data input throughout the care team to reduce or remove bottlenecks, assignment of responsibility for specific activity, and real-time objective monitoring of the work process. Methods: Using the reporting system functionality of a certified EMR deployed in a two-physician medical oncology practice at the New London Cancer Center, the objective measurement of the ability of each of the eligible providers in the clinic to improve their individual MU scores was tracked. Analysis of the progress of each provider revealed gaps. Process issues were identified by work group: secretaries, laboratory preparation and phlebotomy staff, nurses, and clinicians. The designated physician leader met with each group to discuss the sections relevant to that particular group. Results: By discovering and addressing work processes that were not utilizing the ability of the EHR to capture and document (ie, meaningful use of the EHR), rapid progress that affected all of the eligible providers and all patients cared for was made. Changes resulted in increased clarity of clinical and administrative responsibilities during patient processing and clinical care provision. Meaningful use attestation was completed in 14 weeks. Conclusion: Completion of the documentation necessary to meet the requirements of the EHR Incentive Program led to the discovery of systemic inefficiencies in administrative and clinical workflows. Addressing these bottlenecks, along with using the reporting capability of the EHR to measure the impact of workflow changes, enabled the administrative and care teams to make changes quickly and effectively. The certified EHR provided guidance and status-reporting capabilities that allowed the practice to achieve the meaningful use requirement.

scholarly journals Influence of the First Wave of the COVID-19 Pandemic on Cancer Care in a German Comprehensive Cancer Center

2021 ◽  
Vol 9 ◽  
Author(s):  
Johanna Kirchberg ◽  
Anke Rentsch ◽  
Anna Klimova ◽  
Vasyl Vovk ◽  
Sebastian Hempel ◽  
...  
Keyword(s):  
High Volume ◽  
Tumor Stage ◽  
Tumor Board ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Tertiary Referral Center ◽  
Tract Cancer ◽  
Oncological Patients ◽  
Tumor Entity ◽  
The Impact

Introduction: During the first wave of the COVID-19 pandemic in 2020, the German government implemented legal restrictions to avoid the overloading of intensive care units by patients with COVID-19. The influence of these effects on diagnosis and treatment of cancer in Germany is largely unknown.Methods: To evaluate the effect of the first wave of the COVID-19 pandemic on tumor board presentations in a high-volume tertiary referral center (the German Comprehensive Cancer Center NCT/UCC Dresden), we compared the number of presentations of gastrointestinal tumors stratified by tumor entity, tumor stage, and treatment intention during the pandemic to the respective data from previous years.Results: The number of presentations decreased by 3.2% (95% CI −8.8, 2.7) during the COVID year 2020 compared with the pre-COVID year 2019. During the first shutdown, March–May 2020, the total number of presentations was 9.4% (−18.7, 1) less than during March–May 2019. This decrease was significant for curable cases of esophageal cancer [N = 37, 25.5% (−41.8, −4.4)] and colon cancer [N = 36, 17.5% (−32.6, 1.1)] as well as for all cases of biliary tract cancer [N = 26, 50% (−69.9, −15)] during the first shutdown from March 2020 to May 2020.Conclusion: The impact of the COVID-19 pandemic on the presentation of oncological patients in a CCC in Germany was considerable and should be taken into account when making decisions regarding future pandemics.

Abstract 14565: Simultaneous Heart-Kidney Transplant - Does Hospital Experience With Heart Transplant or Kidney Transplant Have a Greater Impact on Patient Outcomes?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael A Catalano ◽  
Stevan Pupovac ◽  
Brian Lima ◽  
Gerin R Stevens ◽  
Alan R Hartman ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Heart Transplant ◽  
Multivariable Analysis ◽  
High Volume ◽  
Patient Demographics ◽  
Improved Outcomes ◽  
Institutional Experience ◽  
One Year ◽  
Mortality Table ◽  
The Impact

Objective: High institutional transplant volume is known to be associated with improved outcomes in heart transplant and kidney transplant. However, little is known regarding the impact of institutional experience on outcomes in simultaneous heart-kidney transplant (SHKT). The aim of this study was to assess trends and outcomes of SHKT nationally, as well as the impact of institutional heart and kidney transplant volume on mortality for SHKT patients. Methods: All adult patients (age ≥18) who underwent SHKT between 2005 - 2019 were identified using the United Network for Organ Sharing (UNOS) database. Annual institutional volume in heart transplant and kidney transplant were determined. Univariate and multivariable analyses were conducted to assess the impact of patient demographics, comorbidities, and institutional transplant volumes on 1-year mortality. Results: There were 1564 SHKT identified in the sample, increasing fourfold from 54 in 2005 to 221 in 2019 (p < .001). Median annual institutional heart transplant volume among centers performing SHKT was 35 (IQR 24 - 56); median annual kidney transplant volume was 166 (IQR 89 - 224). One-year mortality was 11.8%. In multivariable analysis, increasing annual institutional heart transplant volume was associated with reduced 1-year-month mortality. Contrarily, annual institutional kidney transplant volume was not associated with mortality. Increasing body mass index, dialysis, requirement for extracorporeal membrane oxygenator support (ECMO) at time of transplant, ischemic times, and total bilirubin levels were independently associated with increased 1-year mortality (Table 1). Conclusion: Increased institutional heart transplant volume is associated with reduced mortality in SHKT. A similar association was not identified between institutional kidney transplant volume and mortality. Thus, emphasis should be placed on high-volume heart transplant centers to manage SHKT patients.

Sign in / Sign up

Export Citation Format

Share Document