Dean H. Gesme

Strategic use of clinical pathways.

Clinical pathways are detailed, evidence-based processes for delivering cancer care for specific patient presentations. Some oncologists have embraced clinical pathways, while others resist.

Essentials of Staff Development and Why You Should Care

Physicians may reason that their energy, education, and training should be focused on patient care and research, whereas staff education should be the responsibility of practice managers. But physicians have an important role in staff development.

How to Implement Change in Practice

Learn what it takes to overcome the status quo and implement change because stagnation can jeopardize the future of your practice.

How to Negotiate With Health Care Plans

With practice expenses increasing, boosting reimbursement from private payers is one way to stay in business. But successful negotiation is easier said than done.

Subspecialization in Community Oncology: Option or Necessity?

Specializing in a particular type of cancer is one way to manage the explosion of knowledge in oncology. What would subspecializing mean for practitioners, patients, and the community?

Advance Care Planning With Your Patients

Studies have shown that patients want their doctor to talk to them about their advance care plans, and they want that discussion sooner rather than later.

A Financial Counselor on the Practice Staff: A Win-Win

Patients with cancer are often burdened by financial stresses during treatment. The presence of a financial counselor can help alleviate these concerns for both patients and providers.

Survey of Provider Perspectives on Patient Assistance Programs

This survey attempts to quantify the costs of applying for patient assistance programs, which oncologists say too often involves weeks of paperwork, repeated telephone calls, and bureaucratic delays.

Performance Appraisal: A Tool for Practice Improvement

Yours may be among the many oncology practices without an appropriate performance review system in place. Lack of an effective evaluation system increases the risk of inefficiency, poor office morale, and high turnover rates.

Creating Virtual Integration and Improved Oncology Care Quality Through a Co-Management Services Agreement.

PURPOSE Implementation of a co-management services agreement (Co-MSA) creates agreed-upon cancer care delivery quality metrics, a forum for discussion of service line oversight, and virtually integrated care without institutional employment of oncologists. The goal of this project was to demonstrate that a Co-MSA improved predefined quality metrics and provided enhanced communications between a health systems oncology service line and a group of independent oncologists. METHODS Iterative planning discussions were scheduled biweekly over an 18-month period. Contractual, quality, and clinical data with benchmarking were considered in the creation of the Co-MSA. Review of the first years implementation occurred through examination of the metric achievements and qualitative themes that arose through committee meetings, clinical implementation processes, and cross-organizational discussions. RESULTS Metrics designed for the Co-MSA included improved adherence to the breast cancer, colon cancer, and non-small-cell lung cancer level I pathways; improvement of the medical oncology physician communication component of the hospital systems Hospital Consumer Assessment of Healthcare Providers and Systems survey scores; and increased delivery of survivorship care plans to appropriate patients. Nonquantifiable themes from the first year of implementation included the need for technology to collect data, both organizations needing a wider understanding of quality improvement techniques, and a need for greater executive leadership involvement. CONCLUSION In its first year, the Co-MSA resulted in improvement of the delivery of survivorship care plans and adherence to value pathways powered by the National Comprehensive Cancer Network. Improvement of Hospital Consumer Assessment of Healthcare Providers and Systems scores did not occur.