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Running head: TASK 4

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Task 4 Mary Ann Cagle WGU

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As part of Trinity Community Hospital’s (TCH) five-year plan, a community health needs assessment (CHNS) was completed. This assessment focused on the possibility of three service lines: cardio-vascular, oncology and orthopedics. This report will specifically present the viability of an oncology service line development to meet the needs of the community served by TCH. 1. The CHNA revealed the following data supporting the demand for oncologic services: 

In the next five years, oncologic services will experience dramatic growth as 15% of our citizens will reach 65 years of age.

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Cancer incidence growth rates are predicted to grow by greater than 34% to 4,282 new cases in this county.

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Current available resources including physicians, nurses and necessary equipment have reached capacity and are disjointed.

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There are significant deficiencies in the availability and standardization of educational, preventative and supportive programs serving our population. The American Cancer Society statistics point out that one in three people will be

diagnosed with cancer in their lifetime. Additionally, nine out of ten cancer diagnoses occur over the age of 50. ("Who gets cancer?," n.d.)Although demand for oncology service is high, the two available cancer programs servicing our region are seven and ten miles away. Additionally, both programs are poorly organized and without ACOS accreditation. 2. Current Health Care Trends Navigation became part of the oncology care continuum in 1990 when Harold Freeman, MD created a program to shorten time to care for breast cancer patients in Harlem.("AONN

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white paper on navigation standards," 2017)Since that time navigation programs have slowly grown in standardization and importance in cancer care across the world. Canada, Africa, and Australia are a few of the countries that are increasing the utilization of navigators for serious illnesses especially.(Park, Johnston, Urquhart, Walsh, & McCallum, 2018) The cost and complexity of oncology care necessitate the need for a professional to assist a patient and their caregiver through their treatment into survival. Adopting this trend will prove beneficial as we develop our oncology program. Navigators will be the liaison between the patient and TCH as patients negotiate financial, legal and social support as well as myriad appointments, treatment modalities, and insurance companies. Navigators will benefit the patient and TCH by decreasing costs. Patients are more consumer-driven. Precision medicine while increasing curative and survival rates is costly. Increased survival leads to increased comorbidities. Reimbursement is moving toward a pay for performance model. To combat these trends the University of Alabama implemented a navigation program for high-risk patients and realized a $4,000.00 per patient savings over a two year period. (Zaleski, 2017)Navigation services benefit both the patient and the hospital. An additional worldwide trend is leveraging technology to improve patient care and access to care. Utilization of telemedicine and AI in radiation and diagnostic models will improve outcomes, increase avenues for collaboration and decrease costs. ("2019 US and global health care industry outlook," 2019) These are only two of multiple health care trends used across the world that TCH can leverage to build an exceptional oncology program. 3. Supporting Services

TASK 4 The TCH system has the following established medical specialties to support our oncology program: 

Family practice, internal medicine, and geriatrics

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General and thoracic and gynecologic surgery

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ENT, urology, GI, pulmonology, cardiology

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Radiology, pathology, laboratory and emergency medicine The basic infrastructure of radiology, lab and pathology will support oncology

services and will require little modification. Referrals will be generated from family practice, geriatric and internal medicine. Typical oncology programs are heavy in breast, lung and prostate cancers. Those specialties along with our surgical specialists and oncologists will develop natural referral patterns supporting one another to meet the patient’s needs while growing the service line. Our goal and our messaging will be to provide all needed care on our campus close to home. This will provide convenience for our patients while maintaining clear communication between our departments. 5. Fiscal feasibility FY18 ended in a net loss of -$1,495,000 primarily the result of lost patient volume. This loss is mitigated by a $25 mil reserve, some of which will be used to fund the necessary startup equipment. The current estimate of capital expenses are $8 mil for purchase and build out of a linear accelerator, CT Simulator, and an infusion suite. This leaves a reserve of $16.4 mil to cover expenses until a steady revenue stream is established.

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Our initial proforma for a five-year period is as follows and demonstrates a strong return on investment. This does not include the potential downstream revenue generated by supportive services and integrated specialties.

gross charges

value

predicted five-

gross collections

oncology charges per

$ 70,000.00

year growth 382

$ 26,740,000.00

discharge radiation charges per

$

450.00

9100

$

4,095,000.00

treatment chemo charges per

$

600.00

7000

$

4,200,000.00

treatment total charges collection rate

35%

$ 35,035,000.00 $ 12,262,250.00

ratio of cost to charges

30%

$ 10,510,500.00

6. Marketing Marketing and our physician liaison team will be brought in to develop an action plan to include at a minimum the following items: 

Early and regular quarterly physician peer to peer visits to put a name with a face and develop relationships. Oncology liaisons for Texas Oncology report that every physician peer to peer visit generates 3.5 referrals.(Lisa Kennedy, personal communication, January 31, 2019)

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Plan a newspaper, local radio, internet and billboard advertising campaign focusing on community cancer care close to home. Begin three months out with messaging changing monthly.

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Plan a physician mixer/card swap after hours for a meet and greet to continue to develop relationships.

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Begin development of CEU based in-services to target specialties i.e. lung, breast, colon, prostate. This will fill a need for these physicians' groups.

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Oncologists are to develop and participate in grand rounds and tumor boards. Provide opportunities for family practice and internal medicine to present as well. Explore the best time for these programs.

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Begin recruitment program for OCN certified RNs and research RNs 6 months before opening.

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Hold brown bag lunch and learns in the community library along with cancer screening events to stimulate interest in our cancer program B. PowerPoint Presentation 1. See attached

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. (n.d.). Retrieved from https://globalcancerinstitute.org/enhancing-access/ 2019 US and global health care industry outlook. (2019). Retrieved from https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/us-andglobal-health-care-industry-trends-outlook.html# Academy of oncology nurse & patient navigators announces standardized navigation metrics . (2017). Retrieved from https://aonnonline.org/education/articles/10-aonn-announcesstandardized-navigation-metrics Global oncology trends 2018. (2018). Retrieved from https://www.iqvia.com/institute/reports/global-oncology-trends-2018 Park, G., Johnston, G. M., Urquhart, R., Walsh, G., & McCallum, M. (2018, June). Comparing enrolees with non-enrolees of cancer-patient navigation at end of life. Current Oncology, 25(3), e184-e192. http://dx.doi.org/10.3747/co.25.3902 Who gets cancer? (n.d.). Retrieved from https://www.cancer.org/treatment/understanding-yourdiagnosis/after-diagnosis/who-gets-cancer.html Zaleski, A. (2017). 5 Healthcare trends impacting cancer care. Retrieved from https://medcitynews.com/2017/03/5-healthcare-trends-impacting-cancer-care/...