2011 ncra educational conference

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Presentation for Pacific Oncology Data Management Association. Information from the 2011 NCRA educational conference.

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  • I’d like to thank PODMA and HTR for giving me this opportunity to attend this conference.
  • The ones in orange were requested by PODMA members for me to attend. The first three in orange are topics that members wanted me to attend.
  • This chart shows calculated FTEs recommended for a registry size.
  • When you go to the higher ups to request for additional FTEs, you need to make a case of how your registry differs from the guidelines.
  • Guam: Maylani
  • She put together site combinations so that you get some hard sites and some easy sites. When the abstractors are done with their list, they request another list for a different zone.
  • For RHIA, you need 30CEUs so 6 of those need to be ICD-10CM specific.
  • 3 places were discussed.
  • You can find it at seer.cancer.gov under the Information for Cancer Registrars Tab. On the left you will find the link for SINQ.
  • There is a concern about Experts vsDeskperts: So how do you know if the answer you are getting is correct or are you getting answer from some bum on the street? There are more, but these are the more recognizable names.
  • Experts will always quote the page and section where the information can be found.
  • It is also a forum covering a wider variety of topics
  • Provided by the commission on cancer
  • In simple words, you are sending in information in real time and they will, in turn, provide you information on how your hospital is doing in comparison to other hospitals. They also will send you notifications of expected treatments for the patient.
  • Sop= standard operating procedure
  • Like a tickler file.
  • For instance Mary Tyler Moore underwent brain surgery for a benign tumor. You can parlay that news and disseminate how many benign brain surgeries your hospital has done. Survival rates for benign brain patients etc. Send that to your neurosurgeons, maybe a news blast, etc.
  • Clp=cancer liason physician.
  • 2011 ncra educational conference

    1. 1. 2011 NCRA Educational Conference<br />
    2. 2. Topics of Interest<br /><ul><li>NCRA Workload Study of Hospital Registries
    3. 3. Streamlining Quality Abstracting
    4. 4. Effects of ICD-10-CM on AHIMA Credentials</li></ul>Where to Find Answers<br />The Rapid Quality Reporting System (RQRS)<br />E-cancer Reporting<br />New COC Survey Process<br />
    5. 5. NCRA Workload Study of Hospital Cancer Registries<br />
    6. 6. NCRA Workload Study of Hospital Cancer Registries<br />Previous study found a need for staffing guidelines in order to advocate for needed staffing.<br />Provide registries with national staffing and workload data to benchmark their own registries.<br />
    7. 7. NCRA Workload Study of Hospital Cancer Registries<br />1,240 registries invited to participate and 662 registries participated (53% response).<br />Hospitals recorded & reported current workload hours by activity:<br />Core activities (casefinding, abstracting, f/u)<br />QA activities (editing/audits, data analysis)<br />Other (research, cancer committee, training)<br />
    8. 8. NCRA Workload Study of Hospital Cancer Registries<br />Highlights<br />Estimate 1.6 FTE needed for smallest registry (100-500 new cases/year)<br />For every 500 case increase = increase of 1 FTE<br />Need additional FTE to increase target completion rate of 90%<br />Current case completion rate for all participating registry sizes was 80%<br />
    9. 9. NCRA Workload Study of Hospital Cancer Registries<br />* The increase in .1 FTE is lower than the general linear increase in FTEs in the rest of the matrix. If the increase of 1 FTE is applied to remainder of the matrix, each FTE count would be approximately 1.0 FTE higher.<br />
    10. 10. NCRA Workload Study of Hospital Cancer Registries<br />Hard Copy is available <br />PDF is available at NCRA website<br />http://www.ncra-usa.org/i4a/pages/index.cfm?pageid=3666<br />
    11. 11. NCRA Workload Study of Hospital Cancer Registries<br />NCRA Workload Toolkit will be available.<br />Spreadsheet<br />Enter required information<br />*poof* you are short FTE or over FTE compared to other registries.<br />
    12. 12. NCRA Workload Study of Hospital Cancer Registries<br />What?!? I have more FTEs than I need?<br />The reason might be:<br />More research oriented facility.<br />High number of follow-up cases<br />Paper Charts vs EMR<br />Management time<br />Staff works for other departments<br />Collect data elements no longer required<br />This is a guideline, not a standard.<br />You need to make a case of how your registry differs.<br />
    13. 13. Streamlining Quality Abstracting<br />
    14. 14. Streamlining Quality Abstracting<br />Carolyn Ingram, CTR of Precyse, Manager Registry Services<br />New York Presbyterian, The University Hospital of Columbia & Cornell<br />All abstractors are offsite<br />
    15. 15. Streamlining Quality Abstracting<br />Challenges<br />Coding changes over the years<br />Changes in treatment locations with more treatment done at physician office<br />Increase volume of data collected <br />Multiple abstracting resources<br />Staff retention<br />
    16. 16. Streamlining Quality Abstracting<br />Important areas to Quality<br />Communication<br />Managing workflow<br />Completeness of treatment information<br />
    17. 17. Streamlining Quality Abstracting<br />Communication<br />Email-HIPAA rules apply<br />Fax – each abstractor must have a fax machine to query doctors or facilities<br />IM (instant messaging)-some registrars work odd hours; able to see who is on at the time.<br />
    18. 18. Streamlining Quality Abstracting<br />Workflow<br />Master list is created<br />Zones are assigned<br />Zones are rotated to prevent getting “stale.”<br />
    19. 19. Streamlining Quality Abstracting<br />Completeness<br />Abstractors regularly consult NCCN guidelines to see what treatments may be applicable and query physician if not mentioned in record.<br />Tracking treatment requests – a tickler file is kept.<br />Responses are used to update abstracts.<br />2nd request sent if no response.<br />If no response, you can document to show surveyor that doctors were queried.<br />
    20. 20. Streamlining Quality Abstracting<br />Tips & Tricks<br />Pre-screen casefinding download.<br />Correct site for C80.9<br />No more than 5 minutes to screen case.<br />Consider using an abstracting grid or paper abstract to keep notes on.<br />Take breaks<br />Plan your work around meetings/appointments. Do easy sites on those days.<br />Keep Manager informed of any issues impacting productivity.<br />
    21. 21. Effects of ICD-10-CM on AHIMA Credentials<br />
    22. 22. Effects of ICD-10-CM on AHIMA Credentials<br />Implementation of ICD-10-CM is 10/01/2013.<br />ICD-10 is not the same as ICD-10-CM<br />CM stands for clinical modification<br />CM has expanded codes<br />3 digit ICD-10-CM codes<br />Medical coding will use C61 but registries will still use C61.9<br />
    23. 23. Effects of ICD-10-CM on AHIMA Credentials<br /><ul><li>Laterality changes</li></ul>RUL Lung cancer: C34.11 Cancer registries will still code to C34.1<br /><ul><li>ICD-10 codes not in ICD-O-3</li></ul>Histology based cancers <br />C43 Melanoma of skin (C44)<br />C45 Mesothelioma (C38.4 + histology 9050 to 9053)<br />C46 Kaposi Sarcoma (specific site + histology 9140)<br />
    24. 24. Effects of ICD-10-CM on AHIMA Credentials<br />Planned resources for cancer registrars<br />Annual ICD-10-CM casefinding list<br />ICD-9-CM to ICD-10-CM/ICD-10-CM to ICD-9-CM<br />ICD-10 to ICD-10-CM/ICD-10-CM to ICD-10<br />ICD-O-3 to ICD-10-CM<br /><ul><li>Planned release dates for resources: October 2012
    25. 25. ICD-10-CM is still in DRAFT mode and will be until October 2012</li></li></ul><li>Effects of ICD-10-CM on AHIMA Credentials<br />AHIMA ICD-10-CM CE requirements:<br /> CHPS – 1 CEU<br /> CHDA – 6 CEU<br /> RHIT – 6 CEU<br /> RHIA – 6 CEU<br /> CCS-P – 12 CEU<br /> CCS – 18 CEU<br /> CCA – 18 CEU<br />
    26. 26. Effects of ICD-10-CM on AHIMA Credentials<br />Guidelines for Multiple Credential Holders<br />Certificants who hold more than 1 AHIMA credential will only report the highest numbers of CEUs from among all the credentials held.<br />
    27. 27. Effects of ICD-10-CM on AHIMA Credentials<br />Timeline for Accumulating ICD-10-CM/PCS CEUs<br /> AHIMA certified professionals can begin earning specified CEUs during the period of January 1, 2011 thru December 31, 2013.<br /> AHIMA professionals who completed the AHIMA training academy for ICD-10-CM prior to January 1, 2011 will be allowed to used those CEU hours to fulfill the requirement.<br />
    28. 28. Where to Find Answers<br />
    29. 29. Where to Find Answers<br />SEER Inquiry System (SINQ).<br />CoC/AJCC/CS CAnswer Forum.<br />NCRA E-discussion Groups.<br />
    30. 30. SEER Inquiry System (SINQ)<br />http://seer.cancer.gov/seerinquiry/index.php<br />Submit questions about <br />Hematopoietic rules & database<br />MP/H coding rules<br />SEER*Rx<br />SEER Manual<br />ICD-O-3<br />Other<br />
    31. 31. SEER Inquiry System (SINQ)<br />Search via<br />Category (ie MP/H rules, Colon, Lymph Nodes)<br />Free Text (ie focus, foci, mediastinum)<br />Create Reports for distribution.<br />
    32. 32. CAnswer Forum<br />http://cancerbulletin.facs.org<br />A need to revise I&R system<br />Clunky<br />Slow response/turn around<br />Accessible to all cancer care professionals<br />Foster a community of experts in the registry<br />Mentor your peers<br />Real time answers (1 week turn around)<br />
    33. 33. CAnswer Forum<br />I&R is archived here.<br />Experts vsDeskperts<br />Experts from AJCC/CS/CoC are easily recognizable by an insignia.<br />April Fritz, CTR<br />Donna Gress, RHIT, CTR <br />Deborah Etheridge, CTR<br />
    34. 34. CAnswer Forum<br />Purpose of forum<br />Comparable to asking a co-worker in the next cubicle.<br />Some cases are unique and don’t quite fit the rules.<br />Create a venue for dialogue to identify where improvement is needed.<br />NOT meant to be the rules or used in lieu of the manual.<br />
    35. 35. NCRA E-discussion Group <br />NCRA forums covering a variety of topics:<br />SIG Hospital<br />SIG Central/State<br />Education Training Events<br />Education Students<br />Coding & Staging 2010 changes<br />Commission on Cancer Requirements/Standards<br />
    36. 36. The Rapid Quality Reporting System (RQRS)<br />
    37. 37. The Rapid Quality Reporting System (RQRS)<br />What is RQRS?<br />This system allows participating facilities to report data on patients concurrently, while providing participants notification of treatment expectations, as well as showing a hospital's "real-time" concordance rates relative to the state, other similar hospitals, and hospitals at the national level for select evidence based quality of care measures.  <br />
    38. 38. The Rapid Quality Reporting System (RQRS)<br />Beta Testing Participants<br />65 cancer programs<br />Wide range of registry sizes & types of programs<br />
    39. 39. The Rapid Quality Reporting System (RQRS)<br />Beta site registries report highest levels of satisfaction with RQRS noted high levels of physician collaboration & acceptance.<br />71% of registries reported RQRS changed their workload.<br />Average time committed to RQRS is 6 hrs/week<br />It takes about 5 months to integrate RQRS into SOP.<br />Adoption of RQRS is easier with EMR in place.<br />
    40. 40. The Rapid Quality Reporting System (RQRS)<br />Challenges to RQRS Participation<br />Reviewing case multiple times<br />Patient information is fragmented<br />Staffing & time commitments<br />Physician buy in<br />
    41. 41. The Rapid Quality Reporting System (RQRS)<br />By Participating, your program can:<br />Improve patient care with access to real clinical time performance rates.<br />Evaluate historical performance relative to current practice.<br />Use information in real clinical time interventions to enhance patient care.<br />Alert managing physicians to expected adjuvant care.<br />Prevent patients from falling through the cracks.<br />Compare your cancer program performance rates with other participating cancer programs.<br />Negotiate favorable reimbursement rates with payors through demonstrating adherence to evidence-based guidelines.<br />
    42. 42. The Rapid Quality Reporting System (RQRS)<br />Case Alert Lists<br />Use as a case listing for cases with missing treatment information.<br />Based on guidelines, patient is supposed to have hormones, radiation, etc.<br />Use alerts to reduce risk of patients falling through the cracks<br />Use notes function to leave information on cases already researched.<br />
    43. 43. E-Cancer ReportingWhere will Cancer Registrars Be?<br />
    44. 44. E-Cancer Reporting Where will cancer registrars be?<br />The National Program of Cancer Registries-Advancing E-cancer Reporting and Registry Operations (NPCR-AERRO) is a collaborative effort to advance automation of cancer registration by developing a set of cancer surveillance models, requirements, and products.<br />
    45. 45. E-Cancer Reporting Where will cancer registrars be?<br />Registrars will want to shift to analysis/QC to assure your relevancy to treatment outcomes. <br />Provide survival & outcome analyses. Provide clinicians with useful data.<br />Become a Cancer Resource. <br />Be visible.<br />
    46. 46. The New CoC Survey Process<br />
    47. 47. The New CoC Survey Process<br />This is a result of a survey taken by Cancer Liaison Physicians and Surveyor/Consultant teams in 2010.<br />
    48. 48. The New CoC Survey Process<br />Have previous on-site surveys met your expectations? 96% said yes.<br />Comments:<br />“Send less combative and harsh reviewers.”<br />“Surveyor did not complete record review.”<br />“Surveyor could be more up-front with deficiencies.”<br />“Survey Savvy was helpful.”<br />
    49. 49. The New CoC Survey Process<br />Do you feel the survey process fosters multidisciplinary preparation on the part of the cancer program? 90% said yes.<br />How can this be improved?<br />“I think inclusion of high level administration is a very good improvement. They usually control the budget so their buy-in is essential.”<br /> “Needs to be mandatory that all members attend: CEO, CLP, etc.” <br />
    50. 50. The New CoC Survey Process<br />What one change or addition would most improve the survey agenda?<br />“CLP should take the lead & present CP3R information during the survey.”<br />“Discuss changes in standards and how we can implement them.” <br />“Greater focus on outcome.”<br />“Program directed analysis.”<br />“Two day visit.”<br />“Provide best practices at survey.”<br />
    51. 51. The New CoC Survey Process<br />Changes in 2011 Surveys<br />February-June, 2011 survey: On-site testing of selected new standards to identify:<br />Programs that have already implemented<br />Barriers to implementation<br />Best practices that can be shared with others.<br />Data gathered will be used by the leadership team to finalize new standards.<br />
    52. 52. The New CoC Survey Process<br />2012 transitions for programs<br />2012 surveys review activity for 2009, 2010, 2011<br />Ratings based on current standards<br />2012 survey agenda<br />No significant changes introduced<br />Time allotments adjusted to allow for education & discussion<br />Best practices<br />2012 standards<br />Optional activities identified<br />Tour<br />Surveyor private time prior to summation<br />
    53. 53. The New CoC Survey Process<br />
    54. 54. The New CoC Survey Process<br />
    55. 55. The New CoC Survey Process<br />2012 and Beyond<br />New and improved SAR<br />Pre-populate information from Cancer Programs data base<br />Attach supporting documents to standards page<br />Re-design tables<br />Addressing an identified need of the program<br />Automated review of abstracting timeliness<br />Timeliness calculated from data submissions<br />Surveyor reviews a limited number of abstracts<br />
    56. 56. Thank You!<br />NCRA Conference 2012 <br />April 17 - 20 in Washington, DC<br />Gaylord National Resort & Convention Center<br />

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