Comprehensive Thoracic Oncology Program:
COG Update
CTOP Research Retreat
David NalepinskiDirector, Oncology Service Line & Business Operations
May 23, 2014
Conflict of Interest
I, David Nalepinski, have no conflict of interests related to the material presented within this presentation.
Objectives:
The “Cancer Oncology Group” Defining the Grey Zone Aligning Priorities CTOP Metrics Next Steps
The Patient at the Center…
A couple of definitions…. Clinical Microsystem: “a small group of people who work
together in a defined setting on a regular basis to provide care and the individuals who receive that care” Surgery, HemOnc, RadOnc…. Organized by subspecialties,
sections and “cost centers”
Clinical Mesosystem: Connect microsystems, Surround microsystems.. Can HELP… or can HINDER microsystems The Cancer Oncology Group (COG) is a mesosystem made up
of microsystems
Source: Value by Design: Developing Clinical Microsystems to Achieve Organizational Excellence
The Patient at the Center…
• Screening• Referral
Oncology F/U
Diagnosis TreatmentSupportSurvivorship
Treatment Modality Chemotherapy
Treatment Modality Surgery
Treatment Modality Radiation
RadiologyPathology
DO
S M
ICRO
SYST
EMSE
CTIO
N
RESO
URC
ES
HEM
ON
C M
ICRO
SYST
EMSE
CTIO
N
RESO
URC
ES
RAD
ON
C M
ICRO
SYST
EMSE
CTIO
N
RESO
URC
ES
ANCI
LLAR
Y SE
RVIC
ESVA
RIO
US
SECT
ION
S /D
EPTS
Referring Providers/Primary Care
Tumor Board
THINK PROGRESSION/HORIZONTAL/LONGITUDINAL
Referring Providers/Primary Care
Nutrition/Rehab/Palliative
Research/Clinical Trials
Navigation/Care-Management
Supportive Services
Prevention/Education/Pop Health
CTOP MESO-SYSTEMCTOP MESO-SYSTEM
CTOP MESOSYSTEM
Surg Micro
system
Hem Micr
osystem
RadOnc
Microsyste
m
Incentives: Episodes, FFS, wRVU’s, Cost/Unit
Organization Vision – Market/Geopolitical System
Incentives: ACO, Quality/Cost, Capitation
COG (Mesosystem) Successes!!
Tumor boards Clinical trials Interdisciplinary clinics Some pathway development Patient focused providers and staff Clear “financial impact” picture Strong Q/S program Concepts on the Cancer Center strategic plan
CTOP COG Metrics….
Lung Financial Trends….
Lung Financial Trends….
Lung Financial Trends….
Esophagus Financial Trends….
Esophagus Financial Trends….
Esophagus Financial Trends….
New Lung Cancer Patients
New Lung Cancer Patients
New Lung Cancer Patients
New Esophagus Cancer Patients
New Esophagus Cancer Patients
New Esophagus Cancer Patients
Lung Cancer Referrals (w/ Upper Valley)
Lung Cancer Referrals (w/o Upper Valley)
Esophagus Cancer Referrals (w/ Upper Valley)
Esophagus Cancer Referrals (w/o Upper Valley)
Next Steps…
Disease based Multidisciplinary membership Medical Director who is willing and able to
establish the mission, goals, processes and procedures necessary to optimize the group/program in the areas of patient care, research, and education
Accountability to the Meso-System… the COG
Oncology Service Line Development
Center Director
: Norris Cotton Cancer Center Clinical Organization Structure
Surgery Chair
Medicine Chair Chief(s) Hematology Oncology
Vice President
Center Deputy Director
Chief Radiation Oncology
Nursing Director
NCCC Steering Committee
NCI-CCSG Admin Director
Chair Pathology
Chair Radiology
NCICancer Center Support
Grant
Clin
ical R
ese
arc
h
Transl
ati
onal R
ese
arc
h
Clinical Cancer Committee
Surgery
Radiation
Hematology
Pathology
Radiology
Nursing
Care Coordination
Pharmacy
Care Management
Can
cer
On
colo
gy G
rou
p
Dir
ecto
rs
Patient Conferences
(Tumor Boards)
Head & Neck
BMTSpine
ThoracicEsophagus/Lung
Pediatric
Neuro
Melanoma
LymphomaCutaneous Lymphoma
GYN
GUKidney/ProstateBladder/Testis
GIColon/Liver/
Pancreas
EndocrineThyroid/Pituitary
BreastComprehensive
Interdisciplinary Clinics
Clinical Care Team
Palliation
Care Pathways
Care Pathways
Clinical Research
Patient & Family Centered Care: Elements of Integrated & Coordinated Care
Cancer Oncology Group(s)
Patient Conference
(Tumor Board)
Inte
rdis
cip
lin
ary
Cli
nic
Care Pathway
Decisions
Patient Navigation
Clinical Diagnosis
Treatment Schedule Coordination
“Mini” Patient Care Conference(s)
Treatment Modalities
Measurement: Quality and Safety
Care Management/Supportive Services/Palliation & EOL
Survivorship
Referral
Patient Intake
Suspected Diagnosis
Measurement: Financial & Volume(s)
Education
Shared Decision
Electronic Medical Record (eDH)