2011 ncra educational conference

2011 NCRA Educational Conference

Topics of Interest

• NCRA Workload Study of Hospital Registries• Streamlining Quality Abstracting• Effects of ICD-10-CM on AHIMA Credentials• Where to Find Answers• The Rapid Quality Reporting System (RQRS)• E-cancer Reporting• New COC Survey Process

NCRA Workload Study of Hospital Cancer Registries


• Previous study found a need for staffing guidelines in order to advocate for needed staffing.

• Provide registries with national staffing and workload data to benchmark their own registries.


• 1,240 registries invited to participate and 662 registries participated (53% response).

• Hospitals recorded & reported current workload hours by activity:– Core activities (casefinding, abstracting, f/u)– QA activities (editing/audits, data analysis)– Other (research, cancer committee, training)


• Highlights– Estimate 1.6 FTE needed for smallest registry (100-

500 new cases/year)– For every 500 case increase = increase of 1 FTE– Need additional FTE to increase target completion

rate of 90%• Current case completion rate for all participating

registry sizes was 80%


Registry Size Mean Case Load

Total Calculated FTEs Increase in FTEs (as number of new cases increase)

101-500 1.6

501-1000 2.3 0.6

1001-1500 3.3 1.0

1501-2000 3.4 0.1*

2001-2500 4.6 1.3

2501-3000 6.3 1.7

3001-3500 7.6 1.3

* 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.


• Hard Copy is available

• PDF is available at NCRA website– http://www.ncra-usa.org/i4a/pages/index.cfm?

pageid=3666


• NCRA Workload Toolkit will be available.– Spreadsheet– Enter required information– *poof* you are short FTE or over FTE compared to

other registries.


• What?!? I have more FTEs than I need?• The reason might be:

• More research oriented facility.• High number of follow-up cases• Paper Charts vs EMR• Management time• Staff works for other departments• Collect data elements no longer required

• This is a guideline, not a standard.• You need to make a case of how your registry differs.

Streamlining Quality Abstracting


• Carolyn Ingram, CTR of Precyse, Manager Registry Services

• New York Presbyterian, The University Hospital of Columbia & Cornell

• All abstractors are offsite


• Challenges– Coding changes over the years– Changes in treatment locations with more

treatment done at physician office– Increase volume of data collected – Multiple abstracting resources– Staff retention


• Important areas to Quality– Communication– Managing workflow– Completeness of treatment information


• Communication– Email-HIPAA rules apply– Fax – each abstractor must have a fax machine to

query doctors or facilities– IM (instant messaging)-some registrars work odd

hours; able to see who is on at the time.


• Workflow– Master list is created– Zones are assigned– Zones are rotated to prevent getting “stale.”

Cornell Zones

Zone 1 Head/Neck, Prostate, CNS

Zone 2 Thyroid, Kidney, Breast, Other

Zone 3 Upper GI, Colorectal, Hematopoietic, Bone/Skin/Soft Tissue

Zone 4 Respiratory, Reproductive Organs, Biliary, Urinary


• Completeness– Abstractors regularly consult NCCN guidelines to

see what treatments may be applicable and query physician if not mentioned in record.

– Tracking treatment requests – a tickler file is kept.• Responses are used to update abstracts.• 2nd request sent if no response.• If no response, you can document to show surveyor

that doctors were queried.


• Tips & Tricks– Pre-screen casefinding download.

• Correct site for C80.9• No more than 5 minutes to screen case.

– Consider using an abstracting grid or paper abstract to keep notes on.

– Take breaks– Plan your work around meetings/appointments. Do

easy sites on those days.– Keep Manager informed of any issues impacting

productivity.

Effects of ICD-10-CM on AHIMA Credentials


• Implementation of ICD-10-CM is 10/01/2013.• ICD-10 is not the same as ICD-10-CM– CM stands for clinical modification– CM has expanded codes

• 3 digit ICD-10-CM codes– Medical coding will use C61 but registries will still

use C61.9


• Laterality changes– RUL Lung cancer: C34.11 Cancer registries will still code to

C34.1

• ICD-10 codes not in ICD-O-3• Histology based cancers

– C43 Melanoma of skin (C44)– C45 Mesothelioma (C38.4 + histology 9050 to 9053)– C46 Kaposi Sarcoma (specific site + histology 9140)


• Planned resources for cancer registrars– Annual ICD-10-CM casefinding list– ICD-9-CM to ICD-10-CM/ICD-10-CM to ICD-9-CM– ICD-10 to ICD-10-CM/ICD-10-CM to ICD-10– ICD-O-3 to ICD-10-CM

• Planned release dates for resources: October 2012• ICD-10-CM is still in DRAFT mode and will be until

October 2012


AHIMA ICD-10-CM CE requirements:CHPS – 1 CEUCHDA – 6 CEURHIT – 6 CEURHIA – 6 CEUCCS-P – 12 CEUCCS – 18 CEUCCA – 18 CEU


Guidelines for Multiple Credential HoldersCertificants who hold more than 1 AHIMA credential will only report the highest numbers of CEUs from among all the credentials held.


Timeline for Accumulating ICD-10-CM/PCS CEUsAHIMA certified professionals can begin earning specified CEUs during the period of January 1, 2011 thru December 31, 2013.

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.

Where to Find Answers

Where to Find Answers

• SEER Inquiry System (SINQ).• CoC/AJCC/CS CAnswer Forum.• NCRA E-discussion Groups.

SEER Inquiry System (SINQ)

• http://seer.cancer.gov/seerinquiry/index.php– Submit questions about • Hematopoietic rules & database• MP/H coding rules• SEER*Rx• SEER Manual• ICD-O-3• Other

SEER Inquiry System (SINQ)

Search via• Category (ie MP/H rules, Colon, Lymph Nodes)• Free Text (ie focus, foci, mediastinum)

Create Reports for distribution.

CAnswer Forum

• http://cancerbulletin.facs.org– A need to revise I&R system• Clunky• Slow response/turn around

– Accessible to all cancer care professionals– Foster a community of experts in the registry– Mentor your peers– Real time answers (1 week turn around)

CAnswer Forum

• I&R is archived here.• Experts vs Deskperts– Experts from AJCC/CS/CoC are easily recognizable

by an insignia.• April Fritz, CTR• Donna Gress, RHIT, CTR • Deborah Etheridge, CTR

CAnswer Forum

• Purpose of forum– Comparable to asking a co-worker in the next

cubicle.– Some cases are unique and don’t quite fit the

rules.– Create a venue for dialogue to identify where

improvement is needed.– NOT meant to be the rules or used in lieu of the

manual.

NCRA E-discussion Group

• NCRA forums covering a variety of topics:– SIG Hospital– SIG Central/State– Education Training Events– Education Students– Coding & Staging 2010 changes– Commission on Cancer Requirements/Standards

The Rapid Quality Reporting System (RQRS)


• What is RQRS?– 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.


• Beta Testing Participants– 65 cancer programs– Wide range of registry sizes & types of programs


• Beta site registries report highest levels of satisfaction with RQRS noted high levels of physician collaboration & acceptance.

– 71% of registries reported RQRS changed their workload.– Average time committed to RQRS is 6 hrs/week– It takes about 5 months to integrate RQRS into SOP.– Adoption of RQRS is easier with EMR in place.


• Challenges to RQRS Participation– Reviewing case multiple times– Patient information is fragmented– Staffing & time commitments– Physician buy in


• By Participating, your program can:– Improve patient care with access to real clinical time

performance rates.– Evaluate historical performance relative to current practice.– Use information in real clinical time interventions to enhance

patient care.– Alert managing physicians to expected adjuvant care.– Prevent patients from falling through the cracks.– Compare your cancer program performance rates with other

participating cancer programs.– Negotiate favorable reimbursement rates with payors through

demonstrating adherence to evidence-based guidelines.


• Case Alert Lists– Use as a case listing for cases with missing

treatment information.• Based on guidelines, patient is supposed to have

hormones, radiation, etc.

– Use alerts to reduce risk of patients falling through the cracks

– Use notes function to leave information on cases already researched.

E-Cancer ReportingWhere will Cancer Registrars Be?

E-Cancer Reporting

Where will cancer registrars be? • 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.

E-Cancer Reporting

Where will cancer registrars be? • Registrars will want to shift to analysis/QC to

assure your relevancy to treatment outcomes. • Provide survival & outcome analyses. Provide

clinicians with useful data.• Become a Cancer Resource. • Be visible.

The New CoC Survey Process


• This is a result of a survey taken by Cancer Liaison Physicians and Surveyor/Consultant teams in 2010.


• Have previous on-site surveys met your expectations? 96% said yes.

• Comments:– “Send less combative and harsh reviewers.”– “Surveyor did not complete record review.”– “Surveyor could be more up-front with

deficiencies.”– “Survey Savvy was helpful.”


• Do you feel the survey process fosters multidisciplinary preparation on the part of the cancer program? 90% said yes.

• How can this be improved?– “I think inclusion of high level administration is a

very good improvement. They usually control the budget so their buy-in is essential.”

– “Needs to be mandatory that all members attend: CEO, CLP, etc.”


• What one change or addition would most improve the survey agenda?– “CLP should take the lead & present CP3R

information during the survey.”– “Discuss changes in standards and how we can

implement them.” – “Greater focus on outcome.”– “Program directed analysis.”– “Two day visit.”– “Provide best practices at survey.”


• Changes in 2011 Surveys– February-June, 2011 survey: On-site testing of

selected new standards to identify:• Programs that have already implemented• Barriers to implementation• Best practices that can be shared with others.

– Data gathered will be used by the leadership team to finalize new standards.


• 2012 transitions for programs– 2012 surveys review activity for 2009, 2010, 2011– Ratings based on current standards

• 2012 survey agenda– No significant changes introduced– Time allotments adjusted to allow for education & discussion

• Best practices• 2012 standards

– Optional activities identified• Tour• Surveyor private time prior to summation


• 2012 and Beyond– New and improved SAR• Pre-populate information from Cancer Programs data

base• Attach supporting documents to standards page• Re-design tables

– Addressing an identified need of the program– Automated review of abstracting timeliness• Timeliness calculated from data submissions• Surveyor reviews a limited number of abstracts

Thank You!

NCRA Conference 2012 April 17 - 20 in Washington, DC

Gaylord National Resort & Convention Center

2011 ncra educational conference

Education

Transcript of 2011 ncra educational conference