Alicia Ault

WASHINGTON - Multiple options exist to permanently fix the Medicare Sustainable Growth Rate formula, but each has its cost to physicians, patients, and the program, according to staff analysts for the Medicare Payment Advisory Commission.

Among the options MedPAC staff presented to commissioners at a recent MedPAC meeting were adjusting the SGR's spending targets so that they are no longer cumulative, but are calculated on an annual basis and allowing some flexibility in the target. Both of those options would forgive any excess over the target, removing the annual pay cut threat doctors have endured since 2002 under the SGR, according to Cristina Boccuti, a principal policy analyst for MedPAC. However, forgiving any overage will lead to higher costs for the Medicare program. Neither option would leave any room to offer incentives for improved quality and efficiency, she added.

In the past, MedPAC has recommended setting target growth rates - and payment rates - according to particular service categories; the commission is looking in this direction again. For example, separate categories could be established for primary care, imaging, minor procedures, and anesthesia, allowing rates to more closely track volume of services. But the system might also provide incentives for physicians to order higher-volume (and more highly paid) services, according to Kevin Hayes, another MedPAC principal policy analyst.

Two options that seemed to pique commissioners' interest: exempting certain providers (such as accountable care organizations) from the current SGR target but holding them accountable for other targets, and penalizing physicians who are outliers in resource use.

MedPAC has two contractors working on projects to better determine the valuation of providers' time and resource use; more information will be available at the next commission meeting, Ms. Boccuti said.

Every year since 2002, Medicare has failed to meet the SGR targets, causing physician pay, by law, to be reduced. However, every year, and more recently, two or three times a year, Congress has stepped in to legislate a way to avoid those cuts. Cumulatively, the avoided cuts are becoming an ever-growing debt on the federal ledger.

The White House, in its fiscal 2012 budget proposal, is proposing to reduce that debt over the next 10 years, at a cost of $370 billion.

But the administration has figured out only how to pay for that fix for the first 2 years. The reality is that there's a declining pool of Medicare-specific offsets - required by law - to pay for fixing the SGR, Glenn Hackbarth, MedPAC chairman, said at the meeting. "We're in a deteriorating situation here; we're spiraling down," said Mr. Hackbarth. "This isn't going to get better; it's going to get worse."

He envisions a future where lawmakers will have to take money from education or roads or some other non-health-related area of the budget to pay for the Medicare fix. "And that bothers me," he said.

MedPAC in 2001 saw trouble with the SGR and recommended that it be scrapped. Now, the commission is looking again at ways to overhaul the formula so that physicians do not have to face a constantly shifting landscape. The uncertainty is undermining physician confidence in Medicare and leading some to stop seeing beneficiaries, Mr. Hackbarth noted.

He said the time might be right to work out a "quid pro quo" with physicians: an end to the yearly exercise to avert the SGR cuts in exchange for a payment system that has volume constraints and rewards efficiency and improved quality, or, alternatively penalizes those who fail to meet such targets.

WASHINGTON - Multiple options exist to permanently fix the Medicare Sustainable Growth Rate formula, but each has its cost to physicians, patients, and the program, according to staff analysts for the Medicare Payment Advisory Commission.

Among the options MedPAC staff presented to commissioners at a recent MedPAC meeting were adjusting the SGR's spending targets so that they are no longer cumulative, but are calculated on an annual basis and allowing some flexibility in the target. Both of those options would forgive any excess over the target, removing the annual pay cut threat doctors have endured since 2002 under the SGR, according to Cristina Boccuti, a principal policy analyst for MedPAC. However, forgiving any overage will lead to higher costs for the Medicare program. Neither option would leave any room to offer incentives for improved quality and efficiency, she added.

In the past, MedPAC has recommended setting target growth rates - and payment rates - according to particular service categories; the commission is looking in this direction again. For example, separate categories could be established for primary care, imaging, minor procedures, and anesthesia, allowing rates to more closely track volume of services. But the system might also provide incentives for physicians to order higher-volume (and more highly paid) services, according to Kevin Hayes, another MedPAC principal policy analyst.

Two options that seemed to pique commissioners' interest: exempting certain providers (such as accountable care organizations) from the current SGR target but holding them accountable for other targets, and penalizing physicians who are outliers in resource use.

MedPAC has two contractors working on projects to better determine the valuation of providers' time and resource use; more information will be available at the next commission meeting, Ms. Boccuti said.

Every year since 2002, Medicare has failed to meet the SGR targets, causing physician pay, by law, to be reduced. However, every year, and more recently, two or three times a year, Congress has stepped in to legislate a way to avoid those cuts. Cumulatively, the avoided cuts are becoming an ever-growing debt on the federal ledger.

The White House, in its fiscal 2012 budget proposal, is proposing to reduce that debt over the next 10 years, at a cost of $370 billion.

But the administration has figured out only how to pay for that fix for the first 2 years. The reality is that there's a declining pool of Medicare-specific offsets - required by law - to pay for fixing the SGR, Glenn Hackbarth, MedPAC chairman, said at the meeting. "We're in a deteriorating situation here; we're spiraling down," said Mr. Hackbarth. "This isn't going to get better; it's going to get worse."

He envisions a future where lawmakers will have to take money from education or roads or some other non-health-related area of the budget to pay for the Medicare fix. "And that bothers me," he said.

MedPAC in 2001 saw trouble with the SGR and recommended that it be scrapped. Now, the commission is looking again at ways to overhaul the formula so that physicians do not have to face a constantly shifting landscape. The uncertainty is undermining physician confidence in Medicare and leading some to stop seeing beneficiaries, Mr. Hackbarth noted.

He said the time might be right to work out a "quid pro quo" with physicians: an end to the yearly exercise to avert the SGR cuts in exchange for a payment system that has volume constraints and rewards efficiency and improved quality, or, alternatively penalizes those who fail to meet such targets.

WASHINGTON - Multiple options exist to permanently fix the Medicare Sustainable Growth Rate formula, but each has its cost to physicians, patients, and the program, according to staff analysts for the Medicare Payment Advisory Commission.

Among the options MedPAC staff presented to commissioners at a recent MedPAC meeting were adjusting the SGR's spending targets so that they are no longer cumulative, but are calculated on an annual basis and allowing some flexibility in the target. Both of those options would forgive any excess over the target, removing the annual pay cut threat doctors have endured since 2002 under the SGR, according to Cristina Boccuti, a principal policy analyst for MedPAC. However, forgiving any overage will lead to higher costs for the Medicare program. Neither option would leave any room to offer incentives for improved quality and efficiency, she added.

In the past, MedPAC has recommended setting target growth rates - and payment rates - according to particular service categories; the commission is looking in this direction again. For example, separate categories could be established for primary care, imaging, minor procedures, and anesthesia, allowing rates to more closely track volume of services. But the system might also provide incentives for physicians to order higher-volume (and more highly paid) services, according to Kevin Hayes, another MedPAC principal policy analyst.

Two options that seemed to pique commissioners' interest: exempting certain providers (such as accountable care organizations) from the current SGR target but holding them accountable for other targets, and penalizing physicians who are outliers in resource use.

MedPAC has two contractors working on projects to better determine the valuation of providers' time and resource use; more information will be available at the next commission meeting, Ms. Boccuti said.

Every year since 2002, Medicare has failed to meet the SGR targets, causing physician pay, by law, to be reduced. However, every year, and more recently, two or three times a year, Congress has stepped in to legislate a way to avoid those cuts. Cumulatively, the avoided cuts are becoming an ever-growing debt on the federal ledger.

The White House, in its fiscal 2012 budget proposal, is proposing to reduce that debt over the next 10 years, at a cost of $370 billion.

But the administration has figured out only how to pay for that fix for the first 2 years. The reality is that there's a declining pool of Medicare-specific offsets - required by law - to pay for fixing the SGR, Glenn Hackbarth, MedPAC chairman, said at the meeting. "We're in a deteriorating situation here; we're spiraling down," said Mr. Hackbarth. "This isn't going to get better; it's going to get worse."

He envisions a future where lawmakers will have to take money from education or roads or some other non-health-related area of the budget to pay for the Medicare fix. "And that bothers me," he said.

MedPAC in 2001 saw trouble with the SGR and recommended that it be scrapped. Now, the commission is looking again at ways to overhaul the formula so that physicians do not have to face a constantly shifting landscape. The uncertainty is undermining physician confidence in Medicare and leading some to stop seeing beneficiaries, Mr. Hackbarth noted.

He said the time might be right to work out a "quid pro quo" with physicians: an end to the yearly exercise to avert the SGR cuts in exchange for a payment system that has volume constraints and rewards efficiency and improved quality, or, alternatively penalizes those who fail to meet such targets.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON – President Obama unveiled a plan on April 13 to cut the deficit by $4 trillion over 12 years by, in part, strengthening the Independent Payment Advisory Board (IPAB) to help hold Medicare costs down.

In a mid-afternoon speech delivered at George Washington University, Washington, the president said the IPAB, which many physician groups have objected to, would be empowered to hold Medicare cost growth per beneficiary to the gross domestic product plus 0.5%, starting in 2018.

The IPAB, which was created under the Affordable Care Act, has been viewed by health care providers as a way to slash their Medicare reimbursement.

President Obama said Medicare and Medicaid savings would also be achieved by building on to the Affordable Care Act’s provisions. The health-related nondiscretionary side of the deficit-reduction plan he plans to implement would save $340 billion by 2021—in addition to the $1 trillion in savings the White House has projected for health reform—said the president. An additional investment in patient safety could reduce Medicare costs by $50 billion over the next 10 years, he said.

"We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market," said President Obama.

He also said that he would work with the nation’s governors "to demand more efficiency and accountability from Medicaid." But the White House made it clear in a fact sheet about the deficit cutting plan that the president would not support the block grant concept that has been advanced by several Republican governors.

In addition, said the president, "We will change the way we pay for health care—not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results."

The president also made it clear that he did not approve of the budget plan that was introduced on April 11 by Rep. Paul Ryan (R-Wisc.) and scheduled to be voted on Wednesday afternoon in the House. That budget would essentially privatize the Medicare program for anyone who is 54 years or younger.

"I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs," said President Obama. "We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."

The president said that Vice President Joe Biden will begin meeting with congressional leadership in a few weeks to start discussing his deficit-reduction plan. The aim would be to have an agreement in place by the end of June, said President Obama.

The deficit plan includes a "fail-safe" mechanism: Across-the-board spending reductions would be required if, by 2014, "the projected ratio of debt-to-GDP is not stabilized and declining toward the end of the decade." The spending cuts would not apply to Social Security, low-income programs, or Medicare benefits, according to the White House.

WASHINGTON– Establishing a cancer survivorship program can be rewarding for patients and physicians – and for the cancer center as well – according to representatives from large and small centers that have started such programs.

Cancer survivors are a large and growing population with long-term medical and psychosocial needs. The National Cancer Institute estimates that there are 11.7 million cancer survivors in the United States.

Under the NCI definition, "an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life." In addition, the NCI calls attention to family members, friends, and caregivers who also feel the impact of survivorship.

M.D. Anderson: ‘Graduate’ Certificates

Survivorship programs should be an integral part of any cancer center, said Fran Zandstra, director of cancer survivorship program at the University of Texas M.D. Anderson Cancer Center in Houston. These programs should address the acute phase of illness; the intermediate phase, which includes monitoring and rehabilitation; and the long term, covering wellness and a patient’s reintegration into the world outside the health system, she said at the annual national meeting of the association of community cancer centers.

M.D. Anderson started its survivorship program in 2008, and now has specialized programs for stem cell transplants, head and neck cancers, and gynecologic, breast, thyroid and colorectal cancers. Next up will be lymphoma, said Ms. Zandstra.

This is no small undertaking. M.D. Anderson saw 100,000 patients in 2010. Of those, 32,000 were new patients and 19,000 were long-term survivors, she said. The organization also has 18,000 employees.

Getting physicians on board was not easy, at least initially, said Ms. Zandstra, who is also a registered nurse. She and the colleagues who helped build the program surveyed physicians to ask what they would want to see in terms of transitioning patients to a survivorship program.

Some physicians said that their patients would not want to leave them for care from another doctor, which is a valid concern, said Ms. Zandstra. To get past that, the program created a "graduate" certificate for patients who were transitioning out of oncology and into survivorship.

Survivors are tiered according to risk: Surgical patients are at the lowest risk for complications or relapse, and thus are considered "tier 1." Next are tier 2 patients, who are at risk of complications or a second malignancy after chemotherapy or radiation. Finally, tier 3 contains the highest-risk patients, who have metastatic disease or are deemed at risk for other reasons.

Each disease has an algorithm that clearly states the expectations for how a patient will make his or her way through the survivorship system, including the expected components of each visit, said Ms. Zandstra.

The data collected at every visit go into a care summary that’s called the "Passport Plan for Health." This 2-page document is available for patients through M.D. Anderson’s patient portal, and also to physicians through a Web portal specifically for physicians. The patients are also told to take a paper copy of the care summary to each physician visit, whether it’s at M.D. Anderson or elsewhere.

The cancer center is gauging the program’s success by measuring patient and physician satisfaction, the number of patients eligible for survivorship who are seen, how many are referred for appropriate surveillance, the types and number of services used (such as bone density scans), and the number of passports issued.

Sanford Health: ID Patient Needs

A center does not have to be as big as M.D. Anderson to build such a program, said Becky Ball, a registered nurse and clinical services manager at Sanford Oncology Cancer Clinic, which is part of Sanford Health in Sioux Falls, S.D., and serves an average of 1,400 new cancer patients each year, according to its Web site.

The Sanford staff began with a program in breast cancer. That cancer is a common starting point because the patients are motivated, and there are many survivors. According to the NCI, the most common cancer sites for survivors are female breast (22%), prostate (19%), colorectal (9%), and gynecologic (9%).

At Sanford, staff sought to identify needs from a patient perspective from the outset. One way they did that was by surveying patients during chemotherapy infusions, said Ms. Ball. The cancer center has also collaborated with community organizations to help identify areas of need, and a patient navigator from the American Cancer Society is on campus to help survivors find resources.

The survivorship program is designed to give patients a perception of control and progress; it also coordinates care among the various providers, and helps patients gain an understanding of the process of care, she said. Because Sanford is not a huge institution, it has to maximize its resources. One way it does that is by using midlevel providers to deliver care. Sanford has also strived to differentiate the survivorship visits from regular surveillance visits, said Ms. Ball.

The cancer center is hoping to add survivorship programs in head and neck cancer and gynecologic oncology, she said, encouraging meeting attendees from other cancer centers to establish their own survivorship programs. "You have to start somewhere, or you can’t succeed or fail," she told them.

City of Hope: Research Opportunity

At City of Hope in Duarte, Calif., there had been a long-standing pediatric survivorship program, but the comprehensive cancer center has added breast and prostate cancer, and is developing programs in gastrointestinal, gynecologic, lung, and hematologic cancers, said Denice Economou, a registered nurse and project director for survivorship education for quality cancer care.

The breast cancer program was difficult to get up and running because the oncologists wanted to wait at least 10 years post diagnosis before referring a patient, said Ms. Economou. But now, patients are eligible starting from diagnosis. They get a yearly follow-up visit with a nurse practitioner and medical oncologist, in collaboration with the primary breast oncologist. Patients are assessed for therapy-related complications such as premature menopause, osteoporosis, and depression, among other issues, Ms. Economou said.

Prostate cancer patients are eligible if they are at least 1 year out from initial surgery. They are seen every 6 months for 5 years, and then yearly after that. The focus is on health promotion.

All survivors are given a survivorship care plan, with a summary of the treatment they received for their cancer. It gives the patients something to take to any and all clinicians who may see them throughout their life, she said. And it is all done without the benefit of an electronic medical record.

The survivorship visits also provide an opportunity to enroll patients in research protocols, said Ms. Economou.

CTCA: $18 million in Income

Survivorship programs are also an important part of care at the four hospitals that make up the for-profit Cancer Treatment Centers of America, said Tom Lay, director of the survivorship support program at the company.

CTCA provides a wide range of support services, including patient education; coping strategies; wellness, referral and medical services; and aesthetic services (for breast cancer patients and others needing that type of support). As at the other programs, patients are given a treatment summary and a wellness plan, which is similar to the passport that M.D. Anderson patients receive, said Mr. Lay.

The survivorship program costs about $150,000 a year, but brings in $18 million to CTCA, he said. There are some 1,200 visits a year to physicians and nurse practitioners, resulting in about $150,000 in evaluation and management reimbursement. There is also indirect reimbursement from imaging services, pathology, nutrition, physical therapy, and same-day surgeries such as colonoscopies.

Many community physicians have now begun to refer survivors to CTCA for its program. Those handfuls of referrals are worth some $6.2 million, based on the lifetime costs of caring for cancer survivors, Mr. Lay said.

In the future, CTCA’s survivorship program is looking to take over more of the care for low-risk survivors from oncologists. That frees up the medical oncologist to take on additional new patients, he said.

WASHINGTON– Establishing a cancer survivorship program can be rewarding for patients and physicians – and for the cancer center as well – according to representatives from large and small centers that have started such programs.

Cancer survivors are a large and growing population with long-term medical and psychosocial needs. The National Cancer Institute estimates that there are 11.7 million cancer survivors in the United States.

Under the NCI definition, "an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life." In addition, the NCI calls attention to family members, friends, and caregivers who also feel the impact of survivorship.

M.D. Anderson: ‘Graduate’ Certificates

Survivorship programs should be an integral part of any cancer center, said Fran Zandstra, director of cancer survivorship program at the University of Texas M.D. Anderson Cancer Center in Houston. These programs should address the acute phase of illness; the intermediate phase, which includes monitoring and rehabilitation; and the long term, covering wellness and a patient’s reintegration into the world outside the health system, she said at the annual national meeting of the association of community cancer centers.

M.D. Anderson started its survivorship program in 2008, and now has specialized programs for stem cell transplants, head and neck cancers, and gynecologic, breast, thyroid and colorectal cancers. Next up will be lymphoma, said Ms. Zandstra.

This is no small undertaking. M.D. Anderson saw 100,000 patients in 2010. Of those, 32,000 were new patients and 19,000 were long-term survivors, she said. The organization also has 18,000 employees.

Getting physicians on board was not easy, at least initially, said Ms. Zandstra, who is also a registered nurse. She and the colleagues who helped build the program surveyed physicians to ask what they would want to see in terms of transitioning patients to a survivorship program.

Some physicians said that their patients would not want to leave them for care from another doctor, which is a valid concern, said Ms. Zandstra. To get past that, the program created a "graduate" certificate for patients who were transitioning out of oncology and into survivorship.

Survivors are tiered according to risk: Surgical patients are at the lowest risk for complications or relapse, and thus are considered "tier 1." Next are tier 2 patients, who are at risk of complications or a second malignancy after chemotherapy or radiation. Finally, tier 3 contains the highest-risk patients, who have metastatic disease or are deemed at risk for other reasons.

Each disease has an algorithm that clearly states the expectations for how a patient will make his or her way through the survivorship system, including the expected components of each visit, said Ms. Zandstra.

The data collected at every visit go into a care summary that’s called the "Passport Plan for Health." This 2-page document is available for patients through M.D. Anderson’s patient portal, and also to physicians through a Web portal specifically for physicians. The patients are also told to take a paper copy of the care summary to each physician visit, whether it’s at M.D. Anderson or elsewhere.

The cancer center is gauging the program’s success by measuring patient and physician satisfaction, the number of patients eligible for survivorship who are seen, how many are referred for appropriate surveillance, the types and number of services used (such as bone density scans), and the number of passports issued.

Sanford Health: ID Patient Needs

A center does not have to be as big as M.D. Anderson to build such a program, said Becky Ball, a registered nurse and clinical services manager at Sanford Oncology Cancer Clinic, which is part of Sanford Health in Sioux Falls, S.D., and serves an average of 1,400 new cancer patients each year, according to its Web site.

The Sanford staff began with a program in breast cancer. That cancer is a common starting point because the patients are motivated, and there are many survivors. According to the NCI, the most common cancer sites for survivors are female breast (22%), prostate (19%), colorectal (9%), and gynecologic (9%).

At Sanford, staff sought to identify needs from a patient perspective from the outset. One way they did that was by surveying patients during chemotherapy infusions, said Ms. Ball. The cancer center has also collaborated with community organizations to help identify areas of need, and a patient navigator from the American Cancer Society is on campus to help survivors find resources.

The survivorship program is designed to give patients a perception of control and progress; it also coordinates care among the various providers, and helps patients gain an understanding of the process of care, she said. Because Sanford is not a huge institution, it has to maximize its resources. One way it does that is by using midlevel providers to deliver care. Sanford has also strived to differentiate the survivorship visits from regular surveillance visits, said Ms. Ball.

The cancer center is hoping to add survivorship programs in head and neck cancer and gynecologic oncology, she said, encouraging meeting attendees from other cancer centers to establish their own survivorship programs. "You have to start somewhere, or you can’t succeed or fail," she told them.

City of Hope: Research Opportunity

At City of Hope in Duarte, Calif., there had been a long-standing pediatric survivorship program, but the comprehensive cancer center has added breast and prostate cancer, and is developing programs in gastrointestinal, gynecologic, lung, and hematologic cancers, said Denice Economou, a registered nurse and project director for survivorship education for quality cancer care.

The breast cancer program was difficult to get up and running because the oncologists wanted to wait at least 10 years post diagnosis before referring a patient, said Ms. Economou. But now, patients are eligible starting from diagnosis. They get a yearly follow-up visit with a nurse practitioner and medical oncologist, in collaboration with the primary breast oncologist. Patients are assessed for therapy-related complications such as premature menopause, osteoporosis, and depression, among other issues, Ms. Economou said.

Prostate cancer patients are eligible if they are at least 1 year out from initial surgery. They are seen every 6 months for 5 years, and then yearly after that. The focus is on health promotion.

All survivors are given a survivorship care plan, with a summary of the treatment they received for their cancer. It gives the patients something to take to any and all clinicians who may see them throughout their life, she said. And it is all done without the benefit of an electronic medical record.

The survivorship visits also provide an opportunity to enroll patients in research protocols, said Ms. Economou.

CTCA: $18 million in Income

Survivorship programs are also an important part of care at the four hospitals that make up the for-profit Cancer Treatment Centers of America, said Tom Lay, director of the survivorship support program at the company.

CTCA provides a wide range of support services, including patient education; coping strategies; wellness, referral and medical services; and aesthetic services (for breast cancer patients and others needing that type of support). As at the other programs, patients are given a treatment summary and a wellness plan, which is similar to the passport that M.D. Anderson patients receive, said Mr. Lay.

The survivorship program costs about $150,000 a year, but brings in $18 million to CTCA, he said. There are some 1,200 visits a year to physicians and nurse practitioners, resulting in about $150,000 in evaluation and management reimbursement. There is also indirect reimbursement from imaging services, pathology, nutrition, physical therapy, and same-day surgeries such as colonoscopies.

Many community physicians have now begun to refer survivors to CTCA for its program. Those handfuls of referrals are worth some $6.2 million, based on the lifetime costs of caring for cancer survivors, Mr. Lay said.

In the future, CTCA’s survivorship program is looking to take over more of the care for low-risk survivors from oncologists. That frees up the medical oncologist to take on additional new patients, he said.

WASHINGTON– Establishing a cancer survivorship program can be rewarding for patients and physicians – and for the cancer center as well – according to representatives from large and small centers that have started such programs.

Cancer survivors are a large and growing population with long-term medical and psychosocial needs. The National Cancer Institute estimates that there are 11.7 million cancer survivors in the United States.

Under the NCI definition, "an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life." In addition, the NCI calls attention to family members, friends, and caregivers who also feel the impact of survivorship.

M.D. Anderson: ‘Graduate’ Certificates

Survivorship programs should be an integral part of any cancer center, said Fran Zandstra, director of cancer survivorship program at the University of Texas M.D. Anderson Cancer Center in Houston. These programs should address the acute phase of illness; the intermediate phase, which includes monitoring and rehabilitation; and the long term, covering wellness and a patient’s reintegration into the world outside the health system, she said at the annual national meeting of the association of community cancer centers.

M.D. Anderson started its survivorship program in 2008, and now has specialized programs for stem cell transplants, head and neck cancers, and gynecologic, breast, thyroid and colorectal cancers. Next up will be lymphoma, said Ms. Zandstra.

This is no small undertaking. M.D. Anderson saw 100,000 patients in 2010. Of those, 32,000 were new patients and 19,000 were long-term survivors, she said. The organization also has 18,000 employees.

Getting physicians on board was not easy, at least initially, said Ms. Zandstra, who is also a registered nurse. She and the colleagues who helped build the program surveyed physicians to ask what they would want to see in terms of transitioning patients to a survivorship program.

Some physicians said that their patients would not want to leave them for care from another doctor, which is a valid concern, said Ms. Zandstra. To get past that, the program created a "graduate" certificate for patients who were transitioning out of oncology and into survivorship.

Survivors are tiered according to risk: Surgical patients are at the lowest risk for complications or relapse, and thus are considered "tier 1." Next are tier 2 patients, who are at risk of complications or a second malignancy after chemotherapy or radiation. Finally, tier 3 contains the highest-risk patients, who have metastatic disease or are deemed at risk for other reasons.

Each disease has an algorithm that clearly states the expectations for how a patient will make his or her way through the survivorship system, including the expected components of each visit, said Ms. Zandstra.

The data collected at every visit go into a care summary that’s called the "Passport Plan for Health." This 2-page document is available for patients through M.D. Anderson’s patient portal, and also to physicians through a Web portal specifically for physicians. The patients are also told to take a paper copy of the care summary to each physician visit, whether it’s at M.D. Anderson or elsewhere.

The cancer center is gauging the program’s success by measuring patient and physician satisfaction, the number of patients eligible for survivorship who are seen, how many are referred for appropriate surveillance, the types and number of services used (such as bone density scans), and the number of passports issued.

Sanford Health: ID Patient Needs

A center does not have to be as big as M.D. Anderson to build such a program, said Becky Ball, a registered nurse and clinical services manager at Sanford Oncology Cancer Clinic, which is part of Sanford Health in Sioux Falls, S.D., and serves an average of 1,400 new cancer patients each year, according to its Web site.

The Sanford staff began with a program in breast cancer. That cancer is a common starting point because the patients are motivated, and there are many survivors. According to the NCI, the most common cancer sites for survivors are female breast (22%), prostate (19%), colorectal (9%), and gynecologic (9%).

At Sanford, staff sought to identify needs from a patient perspective from the outset. One way they did that was by surveying patients during chemotherapy infusions, said Ms. Ball. The cancer center has also collaborated with community organizations to help identify areas of need, and a patient navigator from the American Cancer Society is on campus to help survivors find resources.

The survivorship program is designed to give patients a perception of control and progress; it also coordinates care among the various providers, and helps patients gain an understanding of the process of care, she said. Because Sanford is not a huge institution, it has to maximize its resources. One way it does that is by using midlevel providers to deliver care. Sanford has also strived to differentiate the survivorship visits from regular surveillance visits, said Ms. Ball.

The cancer center is hoping to add survivorship programs in head and neck cancer and gynecologic oncology, she said, encouraging meeting attendees from other cancer centers to establish their own survivorship programs. "You have to start somewhere, or you can’t succeed or fail," she told them.

City of Hope: Research Opportunity

At City of Hope in Duarte, Calif., there had been a long-standing pediatric survivorship program, but the comprehensive cancer center has added breast and prostate cancer, and is developing programs in gastrointestinal, gynecologic, lung, and hematologic cancers, said Denice Economou, a registered nurse and project director for survivorship education for quality cancer care.

The breast cancer program was difficult to get up and running because the oncologists wanted to wait at least 10 years post diagnosis before referring a patient, said Ms. Economou. But now, patients are eligible starting from diagnosis. They get a yearly follow-up visit with a nurse practitioner and medical oncologist, in collaboration with the primary breast oncologist. Patients are assessed for therapy-related complications such as premature menopause, osteoporosis, and depression, among other issues, Ms. Economou said.

Prostate cancer patients are eligible if they are at least 1 year out from initial surgery. They are seen every 6 months for 5 years, and then yearly after that. The focus is on health promotion.

All survivors are given a survivorship care plan, with a summary of the treatment they received for their cancer. It gives the patients something to take to any and all clinicians who may see them throughout their life, she said. And it is all done without the benefit of an electronic medical record.

The survivorship visits also provide an opportunity to enroll patients in research protocols, said Ms. Economou.

CTCA: $18 million in Income

Survivorship programs are also an important part of care at the four hospitals that make up the for-profit Cancer Treatment Centers of America, said Tom Lay, director of the survivorship support program at the company.

CTCA provides a wide range of support services, including patient education; coping strategies; wellness, referral and medical services; and aesthetic services (for breast cancer patients and others needing that type of support). As at the other programs, patients are given a treatment summary and a wellness plan, which is similar to the passport that M.D. Anderson patients receive, said Mr. Lay.

The survivorship program costs about $150,000 a year, but brings in $18 million to CTCA, he said. There are some 1,200 visits a year to physicians and nurse practitioners, resulting in about $150,000 in evaluation and management reimbursement. There is also indirect reimbursement from imaging services, pathology, nutrition, physical therapy, and same-day surgeries such as colonoscopies.

Many community physicians have now begun to refer survivors to CTCA for its program. Those handfuls of referrals are worth some $6.2 million, based on the lifetime costs of caring for cancer survivors, Mr. Lay said.

In the future, CTCA’s survivorship program is looking to take over more of the care for low-risk survivors from oncologists. That frees up the medical oncologist to take on additional new patients, he said.

WASHINGTON– Establishing a cancer survivorship program can be rewarding for patients and physicians – and for the cancer center as well – according to representatives from large and small centers that have started such programs.

Cancer survivors are a large and growing population with long-term medical and psychosocial needs. The National Cancer Institute estimates that there are 11.7 million cancer survivors in the United States.

Under the NCI definition, "an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life." In addition, the NCI calls attention to family members, friends, and caregivers who also feel the impact of survivorship.

M.D. Anderson: ‘Graduate’ Certificates

Survivorship programs should be an integral part of any cancer center, said Fran Zandstra, director of cancer survivorship program at the University of Texas M.D. Anderson Cancer Center in Houston. These programs should address the acute phase of illness; the intermediate phase, which includes monitoring and rehabilitation; and the long term, covering wellness and a patient’s reintegration into the world outside the health system, she said at the annual national meeting of the association of community cancer centers.

M.D. Anderson started its survivorship program in 2008, and now has specialized programs for stem cell transplants, head and neck cancers, and gynecologic, breast, thyroid and colorectal cancers. Next up will be lymphoma, said Ms. Zandstra.

This is no small undertaking. M.D. Anderson saw 100,000 patients in 2010. Of those, 32,000 were new patients and 19,000 were long-term survivors, she said. The organization also has 18,000 employees.

Getting physicians on board was not easy, at least initially, said Ms. Zandstra, who is also a registered nurse. She and the colleagues who helped build the program surveyed physicians to ask what they would want to see in terms of transitioning patients to a survivorship program.

Some physicians said that their patients would not want to leave them for care from another doctor, which is a valid concern, said Ms. Zandstra. To get past that, the program created a "graduate" certificate for patients who were transitioning out of oncology and into survivorship.

Survivors are tiered according to risk: Surgical patients are at the lowest risk for complications or relapse, and thus are considered "tier 1." Next are tier 2 patients, who are at risk of complications or a second malignancy after chemotherapy or radiation. Finally, tier 3 contains the highest-risk patients, who have metastatic disease or are deemed at risk for other reasons.

Each disease has an algorithm that clearly states the expectations for how a patient will make his or her way through the survivorship system, including the expected components of each visit, said Ms. Zandstra.

The data collected at every visit go into a care summary that’s called the "Passport Plan for Health." This 2-page document is available for patients through M.D. Anderson’s patient portal, and also to physicians through a Web portal specifically for physicians. The patients are also told to take a paper copy of the care summary to each physician visit, whether it’s at M.D. Anderson or elsewhere.

The cancer center is gauging the program’s success by measuring patient and physician satisfaction, the number of patients eligible for survivorship who are seen, how many are referred for appropriate surveillance, the types and number of services used (such as bone density scans), and the number of passports issued.

Sanford Health: ID Patient Needs

A center does not have to be as big as M.D. Anderson to build such a program, said Becky Ball, a registered nurse and clinical services manager at Sanford Oncology Cancer Clinic, which is part of Sanford Health in Sioux Falls, S.D., and serves an average of 1,400 new cancer patients each year, according to its Web site.

The Sanford staff began with a program in breast cancer. That cancer is a common starting point because the patients are motivated, and there are many survivors. According to the NCI, the most common cancer sites for survivors are female breast (22%), prostate (19%), colorectal (9%), and gynecologic (9%).

At Sanford, staff sought to identify needs from a patient perspective from the outset. One way they did that was by surveying patients during chemotherapy infusions, said Ms. Ball. The cancer center has also collaborated with community organizations to help identify areas of need, and a patient navigator from the American Cancer Society is on campus to help survivors find resources.

The survivorship program is designed to give patients a perception of control and progress; it also coordinates care among the various providers, and helps patients gain an understanding of the process of care, she said. Because Sanford is not a huge institution, it has to maximize its resources. One way it does that is by using midlevel providers to deliver care. Sanford has also strived to differentiate the survivorship visits from regular surveillance visits, said Ms. Ball.

The cancer center is hoping to add survivorship programs in head and neck cancer and gynecologic oncology, she said, encouraging meeting attendees from other cancer centers to establish their own survivorship programs. "You have to start somewhere, or you can’t succeed or fail," she told them.

City of Hope: Research Opportunity

At City of Hope in Duarte, Calif., there had been a long-standing pediatric survivorship program, but the comprehensive cancer center has added breast and prostate cancer, and is developing programs in gastrointestinal, gynecologic, lung, and hematologic cancers, said Denice Economou, a registered nurse and project director for survivorship education for quality cancer care.

The breast cancer program was difficult to get up and running because the oncologists wanted to wait at least 10 years post diagnosis before referring a patient, said Ms. Economou. But now, patients are eligible starting from diagnosis. They get a yearly follow-up visit with a nurse practitioner and medical oncologist, in collaboration with the primary breast oncologist. Patients are assessed for therapy-related complications such as premature menopause, osteoporosis, and depression, among other issues, Ms. Economou said.

Prostate cancer patients are eligible if they are at least 1 year out from initial surgery. They are seen every 6 months for 5 years, and then yearly after that. The focus is on health promotion.

All survivors are given a survivorship care plan, with a summary of the treatment they received for their cancer. It gives the patients something to take to any and all clinicians who may see them throughout their life, she said. And it is all done without the benefit of an electronic medical record.

The survivorship visits also provide an opportunity to enroll patients in research protocols, said Ms. Economou.

CTCA: $18 million in Income

Survivorship programs are also an important part of care at the four hospitals that make up the for-profit Cancer Treatment Centers of America, said Tom Lay, director of the survivorship support program at the company.

CTCA provides a wide range of support services, including patient education; coping strategies; wellness, referral and medical services; and aesthetic services (for breast cancer patients and others needing that type of support). As at the other programs, patients are given a treatment summary and a wellness plan, which is similar to the passport that M.D. Anderson patients receive, said Mr. Lay.

The survivorship program costs about $150,000 a year, but brings in $18 million to CTCA, he said. There are some 1,200 visits a year to physicians and nurse practitioners, resulting in about $150,000 in evaluation and management reimbursement. There is also indirect reimbursement from imaging services, pathology, nutrition, physical therapy, and same-day surgeries such as colonoscopies.

Many community physicians have now begun to refer survivors to CTCA for its program. Those handfuls of referrals are worth some $6.2 million, based on the lifetime costs of caring for cancer survivors, Mr. Lay said.

In the future, CTCA’s survivorship program is looking to take over more of the care for low-risk survivors from oncologists. That frees up the medical oncologist to take on additional new patients, he said.

WASHINGTON– Establishing a cancer survivorship program can be rewarding for patients and physicians – and for the cancer center as well – according to representatives from large and small centers that have started such programs.

Cancer survivors are a large and growing population with long-term medical and psychosocial needs. The National Cancer Institute estimates that there are 11.7 million cancer survivors in the United States.

Under the NCI definition, "an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life." In addition, the NCI calls attention to family members, friends, and caregivers who also feel the impact of survivorship.

M.D. Anderson: ‘Graduate’ Certificates

Survivorship programs should be an integral part of any cancer center, said Fran Zandstra, director of cancer survivorship program at the University of Texas M.D. Anderson Cancer Center in Houston. These programs should address the acute phase of illness; the intermediate phase, which includes monitoring and rehabilitation; and the long term, covering wellness and a patient’s reintegration into the world outside the health system, she said at the annual national meeting of the association of community cancer centers.

M.D. Anderson started its survivorship program in 2008, and now has specialized programs for stem cell transplants, head and neck cancers, and gynecologic, breast, thyroid and colorectal cancers. Next up will be lymphoma, said Ms. Zandstra.

This is no small undertaking. M.D. Anderson saw 100,000 patients in 2010. Of those, 32,000 were new patients and 19,000 were long-term survivors, she said. The organization also has 18,000 employees.

Getting physicians on board was not easy, at least initially, said Ms. Zandstra, who is also a registered nurse. She and the colleagues who helped build the program surveyed physicians to ask what they would want to see in terms of transitioning patients to a survivorship program.

Some physicians said that their patients would not want to leave them for care from another doctor, which is a valid concern, said Ms. Zandstra. To get past that, the program created a "graduate" certificate for patients who were transitioning out of oncology and into survivorship.

Survivors are tiered according to risk: Surgical patients are at the lowest risk for complications or relapse, and thus are considered "tier 1." Next are tier 2 patients, who are at risk of complications or a second malignancy after chemotherapy or radiation. Finally, tier 3 contains the highest-risk patients, who have metastatic disease or are deemed at risk for other reasons.

Each disease has an algorithm that clearly states the expectations for how a patient will make his or her way through the survivorship system, including the expected components of each visit, said Ms. Zandstra.

The data collected at every visit go into a care summary that’s called the "Passport Plan for Health." This 2-page document is available for patients through M.D. Anderson’s patient portal, and also to physicians through a Web portal specifically for physicians. The patients are also told to take a paper copy of the care summary to each physician visit, whether it’s at M.D. Anderson or elsewhere.

The cancer center is gauging the program’s success by measuring patient and physician satisfaction, the number of patients eligible for survivorship who are seen, how many are referred for appropriate surveillance, the types and number of services used (such as bone density scans), and the number of passports issued.

Sanford Health: ID Patient Needs

A center does not have to be as big as M.D. Anderson to build such a program, said Becky Ball, a registered nurse and clinical services manager at Sanford Oncology Cancer Clinic, which is part of Sanford Health in Sioux Falls, S.D., and serves an average of 1,400 new cancer patients each year, according to its Web site.

The Sanford staff began with a program in breast cancer. That cancer is a common starting point because the patients are motivated, and there are many survivors. According to the NCI, the most common cancer sites for survivors are female breast (22%), prostate (19%), colorectal (9%), and gynecologic (9%).

At Sanford, staff sought to identify needs from a patient perspective from the outset. One way they did that was by surveying patients during chemotherapy infusions, said Ms. Ball. The cancer center has also collaborated with community organizations to help identify areas of need, and a patient navigator from the American Cancer Society is on campus to help survivors find resources.

The survivorship program is designed to give patients a perception of control and progress; it also coordinates care among the various providers, and helps patients gain an understanding of the process of care, she said. Because Sanford is not a huge institution, it has to maximize its resources. One way it does that is by using midlevel providers to deliver care. Sanford has also strived to differentiate the survivorship visits from regular surveillance visits, said Ms. Ball.

The cancer center is hoping to add survivorship programs in head and neck cancer and gynecologic oncology, she said, encouraging meeting attendees from other cancer centers to establish their own survivorship programs. "You have to start somewhere, or you can’t succeed or fail," she told them.

City of Hope: Research Opportunity

At City of Hope in Duarte, Calif., there had been a long-standing pediatric survivorship program, but the comprehensive cancer center has added breast and prostate cancer, and is developing programs in gastrointestinal, gynecologic, lung, and hematologic cancers, said Denice Economou, a registered nurse and project director for survivorship education for quality cancer care.

The breast cancer program was difficult to get up and running because the oncologists wanted to wait at least 10 years post diagnosis before referring a patient, said Ms. Economou. But now, patients are eligible starting from diagnosis. They get a yearly follow-up visit with a nurse practitioner and medical oncologist, in collaboration with the primary breast oncologist. Patients are assessed for therapy-related complications such as premature menopause, osteoporosis, and depression, among other issues, Ms. Economou said.

Prostate cancer patients are eligible if they are at least 1 year out from initial surgery. They are seen every 6 months for 5 years, and then yearly after that. The focus is on health promotion.

All survivors are given a survivorship care plan, with a summary of the treatment they received for their cancer. It gives the patients something to take to any and all clinicians who may see them throughout their life, she said. And it is all done without the benefit of an electronic medical record.

The survivorship visits also provide an opportunity to enroll patients in research protocols, said Ms. Economou.

CTCA: $18 million in Income

Survivorship programs are also an important part of care at the four hospitals that make up the for-profit Cancer Treatment Centers of America, said Tom Lay, director of the survivorship support program at the company.

CTCA provides a wide range of support services, including patient education; coping strategies; wellness, referral and medical services; and aesthetic services (for breast cancer patients and others needing that type of support). As at the other programs, patients are given a treatment summary and a wellness plan, which is similar to the passport that M.D. Anderson patients receive, said Mr. Lay.

The survivorship program costs about $150,000 a year, but brings in $18 million to CTCA, he said. There are some 1,200 visits a year to physicians and nurse practitioners, resulting in about $150,000 in evaluation and management reimbursement. There is also indirect reimbursement from imaging services, pathology, nutrition, physical therapy, and same-day surgeries such as colonoscopies.

Many community physicians have now begun to refer survivors to CTCA for its program. Those handfuls of referrals are worth some $6.2 million, based on the lifetime costs of caring for cancer survivors, Mr. Lay said.

In the future, CTCA’s survivorship program is looking to take over more of the care for low-risk survivors from oncologists. That frees up the medical oncologist to take on additional new patients, he said.

WASHINGTON– Establishing a cancer survivorship program can be rewarding for patients and physicians – and for the cancer center as well – according to representatives from large and small centers that have started such programs.

Cancer survivors are a large and growing population with long-term medical and psychosocial needs. The National Cancer Institute estimates that there are 11.7 million cancer survivors in the United States.

Under the NCI definition, "an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life." In addition, the NCI calls attention to family members, friends, and caregivers who also feel the impact of survivorship.

M.D. Anderson: ‘Graduate’ Certificates

Survivorship programs should be an integral part of any cancer center, said Fran Zandstra, director of cancer survivorship program at the University of Texas M.D. Anderson Cancer Center in Houston. These programs should address the acute phase of illness; the intermediate phase, which includes monitoring and rehabilitation; and the long term, covering wellness and a patient’s reintegration into the world outside the health system, she said at the annual national meeting of the association of community cancer centers.

M.D. Anderson started its survivorship program in 2008, and now has specialized programs for stem cell transplants, head and neck cancers, and gynecologic, breast, thyroid and colorectal cancers. Next up will be lymphoma, said Ms. Zandstra.

This is no small undertaking. M.D. Anderson saw 100,000 patients in 2010. Of those, 32,000 were new patients and 19,000 were long-term survivors, she said. The organization also has 18,000 employees.

Getting physicians on board was not easy, at least initially, said Ms. Zandstra, who is also a registered nurse. She and the colleagues who helped build the program surveyed physicians to ask what they would want to see in terms of transitioning patients to a survivorship program.

Some physicians said that their patients would not want to leave them for care from another doctor, which is a valid concern, said Ms. Zandstra. To get past that, the program created a "graduate" certificate for patients who were transitioning out of oncology and into survivorship.

Survivors are tiered according to risk: Surgical patients are at the lowest risk for complications or relapse, and thus are considered "tier 1." Next are tier 2 patients, who are at risk of complications or a second malignancy after chemotherapy or radiation. Finally, tier 3 contains the highest-risk patients, who have metastatic disease or are deemed at risk for other reasons.

Each disease has an algorithm that clearly states the expectations for how a patient will make his or her way through the survivorship system, including the expected components of each visit, said Ms. Zandstra.

The data collected at every visit go into a care summary that’s called the "Passport Plan for Health." This 2-page document is available for patients through M.D. Anderson’s patient portal, and also to physicians through a Web portal specifically for physicians. The patients are also told to take a paper copy of the care summary to each physician visit, whether it’s at M.D. Anderson or elsewhere.

The cancer center is gauging the program’s success by measuring patient and physician satisfaction, the number of patients eligible for survivorship who are seen, how many are referred for appropriate surveillance, the types and number of services used (such as bone density scans), and the number of passports issued.

Sanford Health: ID Patient Needs

A center does not have to be as big as M.D. Anderson to build such a program, said Becky Ball, a registered nurse and clinical services manager at Sanford Oncology Cancer Clinic, which is part of Sanford Health in Sioux Falls, S.D., and serves an average of 1,400 new cancer patients each year, according to its Web site.

The Sanford staff began with a program in breast cancer. That cancer is a common starting point because the patients are motivated, and there are many survivors. According to the NCI, the most common cancer sites for survivors are female breast (22%), prostate (19%), colorectal (9%), and gynecologic (9%).

At Sanford, staff sought to identify needs from a patient perspective from the outset. One way they did that was by surveying patients during chemotherapy infusions, said Ms. Ball. The cancer center has also collaborated with community organizations to help identify areas of need, and a patient navigator from the American Cancer Society is on campus to help survivors find resources.

The survivorship program is designed to give patients a perception of control and progress; it also coordinates care among the various providers, and helps patients gain an understanding of the process of care, she said. Because Sanford is not a huge institution, it has to maximize its resources. One way it does that is by using midlevel providers to deliver care. Sanford has also strived to differentiate the survivorship visits from regular surveillance visits, said Ms. Ball.

The cancer center is hoping to add survivorship programs in head and neck cancer and gynecologic oncology, she said, encouraging meeting attendees from other cancer centers to establish their own survivorship programs. "You have to start somewhere, or you can’t succeed or fail," she told them.

City of Hope: Research Opportunity

At City of Hope in Duarte, Calif., there had been a long-standing pediatric survivorship program, but the comprehensive cancer center has added breast and prostate cancer, and is developing programs in gastrointestinal, gynecologic, lung, and hematologic cancers, said Denice Economou, a registered nurse and project director for survivorship education for quality cancer care.

The breast cancer program was difficult to get up and running because the oncologists wanted to wait at least 10 years post diagnosis before referring a patient, said Ms. Economou. But now, patients are eligible starting from diagnosis. They get a yearly follow-up visit with a nurse practitioner and medical oncologist, in collaboration with the primary breast oncologist. Patients are assessed for therapy-related complications such as premature menopause, osteoporosis, and depression, among other issues, Ms. Economou said.

Prostate cancer patients are eligible if they are at least 1 year out from initial surgery. They are seen every 6 months for 5 years, and then yearly after that. The focus is on health promotion.

All survivors are given a survivorship care plan, with a summary of the treatment they received for their cancer. It gives the patients something to take to any and all clinicians who may see them throughout their life, she said. And it is all done without the benefit of an electronic medical record.

The survivorship visits also provide an opportunity to enroll patients in research protocols, said Ms. Economou.

CTCA: $18 million in Income

Survivorship programs are also an important part of care at the four hospitals that make up the for-profit Cancer Treatment Centers of America, said Tom Lay, director of the survivorship support program at the company.

CTCA provides a wide range of support services, including patient education; coping strategies; wellness, referral and medical services; and aesthetic services (for breast cancer patients and others needing that type of support). As at the other programs, patients are given a treatment summary and a wellness plan, which is similar to the passport that M.D. Anderson patients receive, said Mr. Lay.

The survivorship program costs about $150,000 a year, but brings in $18 million to CTCA, he said. There are some 1,200 visits a year to physicians and nurse practitioners, resulting in about $150,000 in evaluation and management reimbursement. There is also indirect reimbursement from imaging services, pathology, nutrition, physical therapy, and same-day surgeries such as colonoscopies.

Many community physicians have now begun to refer survivors to CTCA for its program. Those handfuls of referrals are worth some $6.2 million, based on the lifetime costs of caring for cancer survivors, Mr. Lay said.

In the future, CTCA’s survivorship program is looking to take over more of the care for low-risk survivors from oncologists. That frees up the medical oncologist to take on additional new patients, he said.

The Food and Drug Administration has approved peginterferon alfa-2b for adjuvant treatment of melanoma in patients with "microscopic or gross nodal involvement within 84 days of definitive surgical resection, including complete lymphadenectomy."

The drug, to be marketed as Sylatron by Schering Corp., a Merck & Co. subsidiary, is the second melanoma drug to receive FDA approval this year. The first, ipilimumab (Yervoy), was the first drug ever to improve survival of metastatic melanoma in a clinical trial.

Dr. Eric Rubin, Merck's vice president of clinical oncology, said in a statement that the company was "pleased to offer patients with node-positive melanoma this new option [Sylatron] to treat the disease." He pointed out that Sylatron "is the first such therapy approved for the adjuvant treatment of melanoma by the FDA in more than 15 years."

The FDA based its approval on a single study, EORTC (European Organisation for the Research and Treatment of Cancer) trial 18991, "Adjuvant Therapy With Pegylated Interferon Alfa-2b Versus Observation Alone in Resected Stage III Melanoma," the final results of which were published in 2008 in the Lancet (2008:372;117-26).

Peginterferon alfa-2b was shown to prolong relapse-free survival in this study, which enrolled 1,256 patients with resected stage III melanoma, but investigators saw no difference in overall survival. The median relapse-free survival was 34.8 months with peginterferon alfa-2b vs. 25.5 months with observation.

Peginterferon alfa-2b is given subcutaneously, and can be self-injected by melanoma patients. The recommended dose starts at 6 mcg/kg per week for eight doses, and then tapers to 3 mcg/kg per week for up to 5 years. Premedication with acetaminophen is advised when patients start treatment.

A safety analysis in 608 patients who were treated with peginterferon alfa-2b found the most serious adverse events to be fatigue, increased ALT, increased AST, and pyrexia.

Sylatron is contraindicated in patients with a history of anaphylaxis to peginterferon alfa-2b or interferon alfa-2b, and also in those with autoimmune hepatitis or with hepatic decompensation, according to Merck. There is also a boxed warning on the increased risk of depression, suicidal ideation, suicide, and other neuropsychiatric disorders, which is consistent with all interferons.

Prescribing information can be found on the FDA Web site.

The Food and Drug Administration has approved peginterferon alfa-2b for adjuvant treatment of melanoma in patients with "microscopic or gross nodal involvement within 84 days of definitive surgical resection, including complete lymphadenectomy."

The drug, to be marketed as Sylatron by Schering Corp., a Merck & Co. subsidiary, is the second melanoma drug to receive FDA approval this year. The first, ipilimumab (Yervoy), was the first drug ever to improve survival of metastatic melanoma in a clinical trial.

Dr. Eric Rubin, Merck's vice president of clinical oncology, said in a statement that the company was "pleased to offer patients with node-positive melanoma this new option [Sylatron] to treat the disease." He pointed out that Sylatron "is the first such therapy approved for the adjuvant treatment of melanoma by the FDA in more than 15 years."

The FDA based its approval on a single study, EORTC (European Organisation for the Research and Treatment of Cancer) trial 18991, "Adjuvant Therapy With Pegylated Interferon Alfa-2b Versus Observation Alone in Resected Stage III Melanoma," the final results of which were published in 2008 in the Lancet (2008:372;117-26).

Peginterferon alfa-2b was shown to prolong relapse-free survival in this study, which enrolled 1,256 patients with resected stage III melanoma, but investigators saw no difference in overall survival. The median relapse-free survival was 34.8 months with peginterferon alfa-2b vs. 25.5 months with observation.

Peginterferon alfa-2b is given subcutaneously, and can be self-injected by melanoma patients. The recommended dose starts at 6 mcg/kg per week for eight doses, and then tapers to 3 mcg/kg per week for up to 5 years. Premedication with acetaminophen is advised when patients start treatment.

A safety analysis in 608 patients who were treated with peginterferon alfa-2b found the most serious adverse events to be fatigue, increased ALT, increased AST, and pyrexia.

Sylatron is contraindicated in patients with a history of anaphylaxis to peginterferon alfa-2b or interferon alfa-2b, and also in those with autoimmune hepatitis or with hepatic decompensation, according to Merck. There is also a boxed warning on the increased risk of depression, suicidal ideation, suicide, and other neuropsychiatric disorders, which is consistent with all interferons.

Prescribing information can be found on the FDA Web site.

The Food and Drug Administration has approved peginterferon alfa-2b for adjuvant treatment of melanoma in patients with "microscopic or gross nodal involvement within 84 days of definitive surgical resection, including complete lymphadenectomy."

The drug, to be marketed as Sylatron by Schering Corp., a Merck & Co. subsidiary, is the second melanoma drug to receive FDA approval this year. The first, ipilimumab (Yervoy), was the first drug ever to improve survival of metastatic melanoma in a clinical trial.

Dr. Eric Rubin, Merck's vice president of clinical oncology, said in a statement that the company was "pleased to offer patients with node-positive melanoma this new option [Sylatron] to treat the disease." He pointed out that Sylatron "is the first such therapy approved for the adjuvant treatment of melanoma by the FDA in more than 15 years."

The FDA based its approval on a single study, EORTC (European Organisation for the Research and Treatment of Cancer) trial 18991, "Adjuvant Therapy With Pegylated Interferon Alfa-2b Versus Observation Alone in Resected Stage III Melanoma," the final results of which were published in 2008 in the Lancet (2008:372;117-26).

Peginterferon alfa-2b was shown to prolong relapse-free survival in this study, which enrolled 1,256 patients with resected stage III melanoma, but investigators saw no difference in overall survival. The median relapse-free survival was 34.8 months with peginterferon alfa-2b vs. 25.5 months with observation.

Peginterferon alfa-2b is given subcutaneously, and can be self-injected by melanoma patients. The recommended dose starts at 6 mcg/kg per week for eight doses, and then tapers to 3 mcg/kg per week for up to 5 years. Premedication with acetaminophen is advised when patients start treatment.

A safety analysis in 608 patients who were treated with peginterferon alfa-2b found the most serious adverse events to be fatigue, increased ALT, increased AST, and pyrexia.

Sylatron is contraindicated in patients with a history of anaphylaxis to peginterferon alfa-2b or interferon alfa-2b, and also in those with autoimmune hepatitis or with hepatic decompensation, according to Merck. There is also a boxed warning on the increased risk of depression, suicidal ideation, suicide, and other neuropsychiatric disorders, which is consistent with all interferons.

Prescribing information can be found on the FDA Web site.

The Food and Drug Administration has approved peginterferon alfa-2b for adjuvant treatment of melanoma in patients with "microscopic or gross nodal involvement within 84 days of definitive surgical resection, including complete lymphadenectomy."

The drug, to be marketed as Sylatron by Schering Corp., a Merck & Co. subsidiary, is the second melanoma drug to receive FDA approval this year. The first, ipilimumab (Yervoy), was the first drug ever to improve survival of metastatic melanoma in a clinical trial.

Dr. Eric Rubin, Merck's vice president of clinical oncology, said in a statement that the company was "pleased to offer patients with node-positive melanoma this new option [Sylatron] to treat the disease." He pointed out that Sylatron "is the first such therapy approved for the adjuvant treatment of melanoma by the FDA in more than 15 years."

The FDA based its approval on a single study, EORTC (European Organisation for the Research and Treatment of Cancer) trial 18991, "Adjuvant Therapy With Pegylated Interferon Alfa-2b Versus Observation Alone in Resected Stage III Melanoma," the final results of which were published in 2008 in the Lancet (2008:372;117-26).

Peginterferon alfa-2b was shown to prolong relapse-free survival in this study, which enrolled 1,256 patients with resected stage III melanoma, but investigators saw no difference in overall survival. The median relapse-free survival was 34.8 months with peginterferon alfa-2b vs. 25.5 months with observation.

Peginterferon alfa-2b is given subcutaneously, and can be self-injected by melanoma patients. The recommended dose starts at 6 mcg/kg per week for eight doses, and then tapers to 3 mcg/kg per week for up to 5 years. Premedication with acetaminophen is advised when patients start treatment.

A safety analysis in 608 patients who were treated with peginterferon alfa-2b found the most serious adverse events to be fatigue, increased ALT, increased AST, and pyrexia.

Sylatron is contraindicated in patients with a history of anaphylaxis to peginterferon alfa-2b or interferon alfa-2b, and also in those with autoimmune hepatitis or with hepatic decompensation, according to Merck. There is also a boxed warning on the increased risk of depression, suicidal ideation, suicide, and other neuropsychiatric disorders, which is consistent with all interferons.

Prescribing information can be found on the FDA Web site.

The Food and Drug Administration has approved peginterferon alfa-2b for adjuvant treatment of melanoma in patients with "microscopic or gross nodal involvement within 84 days of definitive surgical resection, including complete lymphadenectomy."

The drug, to be marketed as Sylatron by Schering Corp., a Merck & Co. subsidiary, is the second melanoma drug to receive FDA approval this year. The first, ipilimumab (Yervoy), was the first drug ever to improve survival of metastatic melanoma in a clinical trial.

Dr. Eric Rubin, Merck's vice president of clinical oncology, said in a statement that the company was "pleased to offer patients with node-positive melanoma this new option [Sylatron] to treat the disease." He pointed out that Sylatron "is the first such therapy approved for the adjuvant treatment of melanoma by the FDA in more than 15 years."

The FDA based its approval on a single study, EORTC (European Organisation for the Research and Treatment of Cancer) trial 18991, "Adjuvant Therapy With Pegylated Interferon Alfa-2b Versus Observation Alone in Resected Stage III Melanoma," the final results of which were published in 2008 in the Lancet (2008:372;117-26).

Peginterferon alfa-2b was shown to prolong relapse-free survival in this study, which enrolled 1,256 patients with resected stage III melanoma, but investigators saw no difference in overall survival. The median relapse-free survival was 34.8 months with peginterferon alfa-2b vs. 25.5 months with observation.

Peginterferon alfa-2b is given subcutaneously, and can be self-injected by melanoma patients. The recommended dose starts at 6 mcg/kg per week for eight doses, and then tapers to 3 mcg/kg per week for up to 5 years. Premedication with acetaminophen is advised when patients start treatment.

A safety analysis in 608 patients who were treated with peginterferon alfa-2b found the most serious adverse events to be fatigue, increased ALT, increased AST, and pyrexia.

Sylatron is contraindicated in patients with a history of anaphylaxis to peginterferon alfa-2b or interferon alfa-2b, and also in those with autoimmune hepatitis or with hepatic decompensation, according to Merck. There is also a boxed warning on the increased risk of depression, suicidal ideation, suicide, and other neuropsychiatric disorders, which is consistent with all interferons.

Prescribing information can be found on the FDA Web site.

The Food and Drug Administration has approved peginterferon alfa-2b for adjuvant treatment of melanoma in patients with "microscopic or gross nodal involvement within 84 days of definitive surgical resection, including complete lymphadenectomy."

The drug, to be marketed as Sylatron by Schering Corp., a Merck & Co. subsidiary, is the second melanoma drug to receive FDA approval this year. The first, ipilimumab (Yervoy), was the first drug ever to improve survival of metastatic melanoma in a clinical trial.

Dr. Eric Rubin, Merck's vice president of clinical oncology, said in a statement that the company was "pleased to offer patients with node-positive melanoma this new option [Sylatron] to treat the disease." He pointed out that Sylatron "is the first such therapy approved for the adjuvant treatment of melanoma by the FDA in more than 15 years."

The FDA based its approval on a single study, EORTC (European Organisation for the Research and Treatment of Cancer) trial 18991, "Adjuvant Therapy With Pegylated Interferon Alfa-2b Versus Observation Alone in Resected Stage III Melanoma," the final results of which were published in 2008 in the Lancet (2008:372;117-26).

Peginterferon alfa-2b was shown to prolong relapse-free survival in this study, which enrolled 1,256 patients with resected stage III melanoma, but investigators saw no difference in overall survival. The median relapse-free survival was 34.8 months with peginterferon alfa-2b vs. 25.5 months with observation.

Peginterferon alfa-2b is given subcutaneously, and can be self-injected by melanoma patients. The recommended dose starts at 6 mcg/kg per week for eight doses, and then tapers to 3 mcg/kg per week for up to 5 years. Premedication with acetaminophen is advised when patients start treatment.

A safety analysis in 608 patients who were treated with peginterferon alfa-2b found the most serious adverse events to be fatigue, increased ALT, increased AST, and pyrexia.

Sylatron is contraindicated in patients with a history of anaphylaxis to peginterferon alfa-2b or interferon alfa-2b, and also in those with autoimmune hepatitis or with hepatic decompensation, according to Merck. There is also a boxed warning on the increased risk of depression, suicidal ideation, suicide, and other neuropsychiatric disorders, which is consistent with all interferons.

Prescribing information can be found on the FDA Web site.