Relevant, Timely Medical and Radiation Oncology News

Constant advancements in medical technology and healthcare regulations mean the oncology industry is dynamic and fast-changing. To keep clients on the leading edge of what's happening, Revenue Cycle Inc. maintains the news section of its website as a clearinghouse for oncology news, CPT® coding and/or business operations. Whether it's a legal change that could affect our industry or a tip about oncology coding, you'll find it here.

For more information about how our team of expert consultants can help your practice stay current on these industry changes, visit our medical and radiation oncology service page.


July 2018 Radiation Oncology News

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A Discussion on Radiotherapy Survivorship

Cindy C. Parman, CPC, CPC-H, RCC

The goals of cancer treatment include curing the cancer (when possible), prolonging patient survival, and providing the highest possible quality of life both during and after treatment. In cancer, survivorship focuses on the health and life of a person with cancer post-treatment - beyond the diagnosis and treatment phases - until the end of life. Survivorship means different things to different patients, but it generally describes the process of living with, through, and beyond cancer. Current projections estimate that there will be more than 18 million cancer survivors in the United States by 2024. These increasing numbers of cancer survivors have directed a greater focus to the care of cancer patients after treatment.

According to Cancer Treatment & Survivorship Facts & Figures 2016-2017, there are at least three phases of cancer survival:

  1. The time from diagnosis to the end of initial treatment;
  2. The transition from treatment to extended survival; and
  3. Long-term survival.

In addition, survivorship encompasses a range of cancer experiences and trajectories, including:

  1. Living cancer-free after treatment for the remainder of life.
  2. Living cancer-free after treatment for many years, but experiencing one or more serious, late complications of treatment.
  3. Living cancer-free after treatment for many years, but dying after a late recurrence.
  4. Living cancer-free after the first cancer is treated, but developing a second cancer.
  5. Living with intermittent periods of active disease requirement treatment.
  6. Living with cancer continuously, with or without treatment, without a disease-free period.

After the active treatment phase is complete, patients may need to continue supportive therapies, surveillance testing, and monitoring for treatment-related sequelae. According to the American Cancer Society, studies indicate that survivorship care plans (SCP) help survivors feel more informed, make healthier diet and exercise choices, and increase the likelihood that patients will share this information with their healthcare team members.

An SCP is a detailed plan provided to a patient when active treatment ends, based on the specific type of cancer and the actual treatment received. According to the American Cancer Society, the Institute of Medicine issued a report in 2006 recommending that every cancer patient receive an individualized survivorship care plan that includes guidelines for monitoring and maintaining their health. In general, an SCP:

  • Documents a concise history of the patient's cancer treatment (all modalities, including surgery, chemotherapy, immunotherapy and radiotherapy);
  • Provides a platform for patient dialog with all members of the care team, specifically regarding surveillance for recurrence and/or cancer spread (e.g., primary care, medical oncology, surgeon, radiation oncologist, other medical specialists);
  • Establishes follow-up care management services [e.g., what tests will be performed, which provider(s) will continue to evaluate the patient, the timing of diagnostic and follow-up services];
  • Discusses anticipated course of recovery, existing or potential short-term and long-term side effects, and how to manage them or when to contact the healthcare provider (quality of life changes);
  • Provides tools and directions for patient self-care, including physical, emotional and practical issues (e.g., legal and financial needs, psychosocial issues, access to healthcare, referral to supportive care providers, nutrition, physical therapy, lifestyle behavior modification counseling, support groups, and other cancer information resources)'
  • Defines goals for achieving wellness.

The American College of Surgeons Commission on Cancer (CoC) issued a mandate that accredited cancer programs provide SCPs for all curative cancer patients by 2019 to maintain accreditation. These CoC requirements may necessitate changes for radiation oncologists and accredited cancer centers; a March 2014 survey of ASTRO members indicates that only 40 percent of radiation oncologists provided SCPs for curative treatment, and only 19 percent provided an SCP for palliative patients. In addition, ASTRO published a survivorship template in 2015 to help standardize and streamline the creation of patient-focused plans for long-term cancer survivor care following radiation therapy.

While radiation oncologists have traditionally created a radiotherapy treatment summary, a survivorship care plan goes beyond the data in this document. Treatment completion notes were generally created for review by other physicians, with emphasis on the technical details of radiotherapy. The audience for the SCP is the patient and caregiver(s); as a result, there is more emphasis on future care needs.

In summary, a survivorship care plan is intended to educate cancer survivors, improve communication between oncologists and primary care providers, and facilitate coordinated post-treatment health care. In addition, delivery of an SCP to a patient provides an opportunity for the patient to indicate additional areas of concern beyond treatment and toxicity, which can generate necessary referrals and support. Given the significant treatment role and unique toxicities of radiotherapy, a need exists to include this information in a comprehensive survivorship care plan. In the words of Karen Karls, a Minnesota cancer survivor, "A survivor care plan is for the future - an empowering reminder that you still have control of your life. Cancer happened to you, but it does not have to define who you are."


Resources:

1. https://www.cancer.org/treatment/survivorship-during-and-after-treatment/survivorship-care-plans.html  

2. http://mncanceralliance.org/wp-content/uploads/2013/07/SurvivorCarePlan3202012_Final.pdf

3. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/survivorship-care-plan  

4. https://www.cancer.net/survivorship/follow-care-after-cancer-treatment/asco-cancer-treatment-and-survivorship-care-plans  

5. https://www.astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2015/ASTRO-launches-template-to-help-radiation-oncologists-guide-cancer-survivors-through-ongoing-care/

6. https://www.texasoncology.com/who-we-are/oncology-care-model/survivorship

7. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-treatment-and-survivorship-facts-and-figures/cancer-treatment-and-survivorship-facts-and-figures-2016-2017.pdf

8. https://www.cancer.net/sites/cancer.net/files/cancer_survivorship.pdf


September 2017 Medical Oncology

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Back To Basics

When documenting, we all strive to provide supporting documentation for each process. In doing so, sometimes we fail at the basic requirements. We get so caught up in detailing each and every step; listing how many catheters, what type of imaging was utilized, who was present... that we forget the basic information such as: patient's name, identifying factors, date of service, etc.

The Electronic Medical Record should help to eliminate these types of errors by utilizing the available tools and system functionality, but if the beginning process is incorrect, errors can and will occur. The initial creation of an electronic template is a crucial time. Take time to ensure that everything is correct before implementation. Does the document clearly state the date of service? Does the document allow for required elements for the corresponding procedure? Does the document include the required components for an electronic approval or signature? These are some questions to consider when creating an accurate, easy to use document.

It is recommended to utilize a standard format when developing electronic forms and templates to ensure required elements such as dates, patient identifiers and electronic approvals are consistent for all users and procedures. It is further recommended to gauge accurate use and completion of the documentation by the intended users once the document has been implemented. Timely identification and correction of documentation issues may prove to be beneficial in the event of a payer review and could provide improvements in the quality of documentation available for other providers and clinicians. 

To be certain that your practice and facility have the required documentation elements and the medical record supports the services billed, Revenue Cycle Inc. recommend a comprehensive medical record review. For more information on our consulting services, please contact us here or 512-583-2000.