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January 14, 2016
Women’s Health & Oncology
• Women’s Service Line
– Beth Canipe
– Ramada Smith, MD
• Oncology Service Line
– Rick Varterasian
• Opportunities and Challenges of Cancer Care
– Steve Yates, MD
Institute for Community Engagement
Women’s Service Line
January 14, 2016
Beth Canipe – Director
Ramada Smith, MD - Physician Administrator
Women’s Service Line
2015 in REVIEW
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Total Births 2047
27 Twin deliveries
C-Sec rate 29%
Epidural Rate 66%
115 NICU admissions
Accomplishments
A journey toward becoming a Highly Reliable Organization
Clinical Practice Guidelines developed:
- Guidelines for Diabetic C-section patients
- Guidelines for Medically Indicated Delivery
- Guidelines for management of Post Partum Hemorrhage
2015
inforREVIEW
- Guidelines
Premature Rupture of Membranes
- Guidelines for management of Preterm Labor
Women’s Service Line
HRO
 Daily “Safety Hour”
 Developed standardized process for scheduled inductions
 Hardwired shift change safety huddles in Birthplace and formal
huddle board in NICU
 Implementation of EPIC
 Worked with OB offices to standardize breastfeeding education for
our patients
 Re-educated nurses and providers on EMTALA guidelines and
monitor daily
 Implemented bedside reporting by nurses
 Developed Service Line newsletter to improve communication
 Continue to work on Team Stepps
 All labor nurses completed formal fetal monitoring classes
Women’s Service Line
Quality Program
 The Joint Commission Core Measure for OB:
Elective Deliveries - 0
C-Sections- 25.5%
Antenatal Steroids- 100%
Central Line Infections- 1
Breastfeeding- 48%
 Other areas of focus:
Hemorrhage
VTE
Pre-eclampsia
Women’s Service Line
Community
 Held first ever Women’s Advisory Group meeting
 Developed “Winning Weighs for Women”
 Participated in the Women’s Expo and other community
events/health fairs
 Participated in the Teen Pregnancy initiative as a core partner
 Worked with county partners on the STAR initiative
 Welcomed visitors from Canada and Clemson University
 Added one new OB/GYN physician, recruiting for 2 more
physicians and 1 CNM
Women’s Service Line
WHAT’S NEXT
 Continue journey to become a HRO
 Consider Baby Friendly USA designation
 Continue to work on patient and family experience
 Continue to work to be the preferred provider for
women’s services- Women’s Center
 Embed the CaroMont Health Women’s brand
throughout the community
 Continue focus on wellness for women throughout
the age continuum
Institute for Community Engagement
Oncology Service Line
January 14, 2016
Rick Varterasian – Admin Director
Steven Yates, MD – Physician Administrator
Cancer Care in America - 2016
Oncology Service Line Mission
To improve the health of the people and
communities we serve
by providing high quality, safe, timely,
compassionate and cost effective
oncology services that are
nationally recognized and accredited.
Patient Promise
To provide “highly reliable care”.
We define highly reliable as providing
high-quality, value driven, compassionate
care in a timely manner, maintaining
individual safety and privacy.
What is Cancer?
Defining Cancer
Cancer is a term used for diseases in which
abnormal cells divide without control and are able to
invade other tissues.
Cancer is not just one disease but many diseases.
There are more than 100 different types of cancer.
What is Cancer ?
Cancer Core Families
Benign neoplasm
Bladder cancer
Bone cancer and other sarcomas
Bone metastases
Brain/CNS cancer
Breast cancer
Cervical and other female
genital cancers
Colorectal cancer
Head and neck cancers
Hodgkin lymphoma
Leukemias
Liver cancer
Lung cancer
Melanoma
Multiple myelomas
Non-Hodgkin lymphoma
Not otherwise classified and other cancers
Other GI cancers, including stomach and esophagus
Other skin cancer
Ovarian cancer
Pancreas cancer
Prostate cancer
Renal cancer
Testicular and other male genitourinary cancers
Thyroid cancer
Uterine cancer
Cancer Care in America - 2016
Remarkable progress is occurring in cancer treatment, screening and prevention—with 13.7
million cancer survivors living in the United States today.
BUT: a PERFECT STORM of challenges could undermine
patients’ access to life-saving advances.
Health Care Reform Bill - Oncology
The Patient Protection and Affordable Care Act of 2010
1. Select preventive and screening services offered without costsharing (ex. breast, colon)
2. Patients with pre-existing conditions guaranteed coverage.
3. Removal of lifetime and annual caps on coverage.
Cancer Care in America - 2016
A record number of patients will soon need cancer care, but
the oncology workforce isn’t growing fast enough to keep
pace
By 2025, demand for cancer care
is expected to rise by 42% due to
the aging population
But the supply of oncologists
is expected to grow only 28%,
leaving a deficit of almost
1,500 doctors
Cancer Care in America - 2016
Rising Costs of Cancer Care Are
Unsustainable
Cancer Care Costs
(2010-2020)
40% INCREASE
Delivering high-quality,
evidence-based medicine will play a key
role in achieving value for dollars spent.
Trends in Cancer Care - 2016
•Demand for cancer prevention, screening and treatment services growing rapidly.
•By 2025, the number of new cancer cases in US to increase by +42%.
•Cancer will become the nation’s leading cause of death
•Largely as a result of the aging population
•At the same time, the number of survivors will continue to grow.
•The death rate for cancer in the US declined 20% in the past 2 decades.
•Cancer today has become a “chronic disease”.
•More outpatient care.
•Focus on patient centered care – focus on amenities.
Trends in Cancer Care - 2016
•Focus on Outcomes – accountability for quality via adherence to evidence based practice.
Evidenced based – multidisciplinary cancer care.
•Radiation Therapy – “hypofractionation”
Fewer sessions with larger doses per session.
•Personalized Cancer Treatment: “Targeted”
Using genetic analysis to determine which drugs will target a patient’s specific cancer.
Customizing therapy to the cellular makeup of cancer rather than treating all cancers
the same.
Individual approach, aligns with a patient-centered culture, also reduces side effects
and improves symptom management.
•Greater awareness of cost. “Financial toxicity”
Trends in Cancer Care - 2020
The Future
By 2020, the world of cancer care will experience a
fundamental transition with the adoption of a true valuebased framework.
Hospitals & physicians will be reimbursed on cost and
quality – not volume.
Patients will choose to entrust their care to those with a
proven record of success.
Growth Outlook
Incidence Will Continue to Rise as Population
Ages
National Cancer Incidence Projections
2013-2023
Breast
Lung
Prostate
Colon & Rectal
Source: Oncology Roundtable Cancer Incidence Estimator.
Gaston County Cancer Incidence Estimator
Healthcare Advisory Board Projection
35%
34%
30%
35%
30%
21%
25%
20%
18%
20%
15%
16%
15%
11%
10%
10%
5%
0%
Breast
Breast, In Situ
Colon & Rectum
5 Year Growth
2010 - 2015
Lung & Bronchus
10 Year Growth
2010 - 2020
Prostate
Gaston County Smoking
Gaston County
2012 - Community Health Assessment Report
Oncology Universe Pillars
1. Radiation Oncology
2. Medical Oncology
3. Surgical Oncology
New 4th Pillar: Immuno Oncology
National Distinctions:
Service Delivery
The CaroMont Cancer Center provides a
comprehensive approach to the treatment of cancer.
This includes:
Prevention
Early detection
Education
Treatment
Follow-up
Symptom management
Survivorship services
CaroMont Cancer Diagnosis
Breast
Lung
Prostate
Colorectal
All Sites
2010
231
198
120
106
1074
2011
204
186
100
99
1013
2012
259
245
97
95
1195
2013
285
200
105
100
1189
2014
263
222
98
87
1115
24%
20%
9%
8%
CaroMont Cancer Data
County
80
70
60
2009
50
2010
40
2011
2012
30
2013
20
10
0
Gaston
Cleveland
Lincoln
Other
Cancer Patient Age Distribution
Age
35
30
25
2009
20
2010
2011
15
2012
2013
10
5
0
0-49
50-59
60-69
70-79
80+
2015 Key Accomplishments
Oncology Palliative Care Clinic
A collaborative initiative with Gaston Hospice opened its doors this year in the
CaroMont Cancer Center.
Michael Case, MD
With the combined leadership of Michael Case, MD, Gaston Hospice Medical
Director, and Steven Yates, MD, Oncology Service Line Administrator, this
new service is designed to meet the symptom management needs of cancer
patients.
Clinic participants have access to palliative care throughout their experience
with cancer, with the goal of preventing or treating the symptoms and side
effects of the disease and its treatment as well as addressing related
psychological, social and spiritual needs.
Leanne King, NP
Under the guidance of Leanne King, NP, palliative care services offered
through the CaroMont Cancer Center can address a broad range of issues,
integrating an individual’s specific needs into the plan of care.
2015 Key Accomplishments
Patient and Family Advisory Council
The CaroMont Cancer Center established a Patient and Family Advisory Council
this year, containing a mix of past and present oncology patients, family
members and staff to help guide improvement in the quality and overall oncology
patient experience.
Including patients and their families offers a unique perspective to cancer care,
as they are an important part of the care team and can offer valuable feedback
about the care they’ve received.
The Advisory Council provides insights across a number of disciplines during
monthly meetings, including:
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Identifying patient and family needs and concerns.
Providing feedback on current systems and processes.
Generating ideas to improve care.
Act as catalysts and advocates for expanding the patient-centered care
model.
2015 Key Accomplishments
Oncology Nurse Navigation Program
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Complete review, analysis and expansion of program via
Lean Rapid Improvement Event.
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Hiring of new oncology nurses assigned to specific tumor
sites.
Diane Block, RN
Ashley Cloninger, RN
Lindsay Sain, RN
Rebecca Clopp, RN
2015 Key Accomplishments
Radiation Physics
•Expansion of medical dosimetry & radiation physics service
team.
•Develop treatment plans for patients undergoing radiation
therapy.
Wayne Gardner
Chief Physicist
George Hancock
Physicist
Mark Fink
Medical Dosimetrist
Karen Lewis
Medical Dosimetrist
Jennifer Ponder
Medical Dosimetrist
2015 Key Accomplishments
Expanding Psychosocial Support
The CaroMont Cancer Center strives to treat the whole patient, not just
cancer.
This is achieved through multiple support services and programs, including
patient navigation.
Hannah Smith
LCSW
In 2015, we were pleased to welcome Hannah Smith, Licensed Clinical
Social Worker, to the Cancer Center team.
Hannah helps patients, families and caregivers deal with the total experience
of a cancer diagnosis, from treatment into survivorship.
She is trained as an oncology social worker and helps counsel patients with
the psychological, social, emotional and spiritual issues that arise.
We welcome Hannah to the team. Her enthusiasm and passion will continue
to enhance our full-range of services offered to cancer patients.
2015 Key Accomplishments
Oncology Financial Counselor
Assist patients with the financial aspects of receiving cancer care.
Many cancer patients experience financial distress “financial
toxicity”.
Hope Toney
Financial
Counselor
We attempt to lessen the financial burden and improve access to
care during treatment.
The patient financial counselors are insurance experts. They
also have access to a variety of programs that can sometimes
help with drug costs, and even with co-pay and co-insurance
costs, for patients that qualify.
They answer questions and ensure that a coverage plan is in
place before treatment begins.
Opportunities and Challenges of
Cancer Care
Steven Yates, MD
Gaston Hematology & Oncology
Oncology Service Line Physician Administrator
Opportunities of Cancer:
CaroMont Initiatives
Multidisciplinary Clinics
Service Line Developments
(PRIDE, Navigation, Survivorship, Palliative Care)
Performance Improvement Activities
Expanded services including genetics
Screening programs
Patient Assistance Activities
Opportunities of Cancer:
Successful Factors
Real advances in Survival of Stage 4 Cancers
Increased cures in Stages 2 and 3 Cancers
Major development in hematologic malignancies
Explosion of genetics
New Treatments
Better palliation of symptoms
Opportunities of Cancer:
Challenging Factors
Genetic targets exceed available drugs
Multiple mutations create resistance
Explosion of molecular tests
Complexity of therapies
Cost of new drugs
Other costly items
Cost of Cancer: Driving Factors
Drugs
Surgical Developments
New Imaging Options
New Radiation Options
Immune Therapies
Molecular Testing
Cost of Cancer: Driving Factors
Demographic changes (Disease
prevalence)
More expensive treatments
More aggressive care (more options
while living longer)
Changes in the site of care
Cost of Cancer: Drugs
$ 15 billion + annually
Dramatically less than
projected
Cost of Cancer: Perspective
In spite of the cost of new agents, Cancer
treatment costs have not grown faster than
that of all of healthcare. And pharmaceutical
expenses are still a minor portion of the total
cost of Cancer treatments.
Opportunities in Cancer
Real advancements are being made.
Survival is at an all time high for cancer
patients. In spite of challenges and
changes in healthcare it is a great time
to be working with cancer.
Road to CaroMont Oncology Excellence