The cancer registry can have a great impact on the growth of an Accountable Care Organization (ACO). This white paper takes an in-depth look at the topic.

1. Cancer Registry Poised to Support Accountable Care
Reimbursement & Strengthen the Bottom Line
Focus on quality of care and quality of data leads innovative organizations
and fiscally focused executives to increasingly turn to the cancer registry

2. Introduction: Accountable
Care, the Bottom Line and
the Cancer Registry
Recently profiled in the April 23, 2013 New York Times
article, “A Health Provider Strives to Keep Hospital
Beds Empty,” Advocate Health Care has embraced
accountable care and has already achieved a
two percent cost savings as a direct result.
According to the article, thus far, hospital
admissions are down six percent, and days spent
in the hospital are down nearly nine percent. To
facilitate the change, “Advocate has hired scores
of workers to coordinate care and keep an eye on
the highest-cost patients...”
According to the same NY Times article, an
estimated 428 accountable-care organizations now
cover four million Medicare enrollees and millions
more people with private insurance.
Executives should take the time to examine the
sources of their organizations’ data and how they
acquire and report that data. Turning to the best
data sources can boost reimbursement and
financial performance of cancer centers and
their parent organizations, and the best source for
data related to cancer is undoubtedly the cancer
registry department.
Cancer registries already maintain
the highest quality data
Data quality’s impact on
patient care, outcomes and
the bottom line
Throughout the industry, the many ways
organizations have begun to harness cancer
registry data speaks to their confidence in the
quality of that data. At some of the hospitals
and health networks that work with Care
Communications to ensure efficiency and
effectiveness in cancer registry departments,
cancer registry data has been effectively put to
use in many different ways. Already, organizations
use cancer registry data to justify new investments
in technology or medical expertise. Many use
the data to grade their own cancer center’s
performance against benchmarks, determine
if patients receive appropriate treatment, and
educate physicians on what standards of care
should be. In other instances, organizations use
the data to analyze referral patterns or better
understand their customer base. As more
organizations begin to understand the value of
this data as a competitive advantage for critical
analysis and decision making, the industry’s
growing confidence in the quality of data from the
cancer registry will most likely only continue to rise.
This makes perfect sense, considering the origin of
that data.
Suspect data affects patient outcomes, and
in accountable care organizations this also
harms financial performance. Accountable
care organizations link payments to quality
improvements and cost reductions, a practice
that will spread to cancer care soon. The deeper
hospitals move into pay for performance, the
more data their executives will need to prove
quality of care.
Abstracted by trained professionals, the cancer
registry is a reliable, yet under-utilized source of
cancer outcomes data. To ensure data quality
standards, cancer registries remain highly
regulated but offer the flexibility to be easily
expanded in an organization’s efforts to collect
additional helpful information and data that can
further enhance patient care or the organization’s
bottom line.
While many pundits believe the accountable care
movement could be the most meaningful recent
development in the effort to fix our nation’s health
care industry, hospital executives are only beginning
to open their eyes to the powerful role their cancer
registries can play in the quest for profitability during
and beyond the transition. Critically important, the
quality of data collection directly affects patient
outcomes and reimbursement, and executives
should take a few simple steps today to assess the
quality of their cancer registry data, begin to use
it more effectively and improve future financial
performance.
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3. Cancer registries...
(cont’d)
Turning to the cancer registry as a trusted source
for data ensures quality, thanks to the American
College of Surgeons (ACoS) Commission on
Cancer (CoC) and its stringent regulations on data
quality. Its published standards for data quality i
require all case abstracting to be performed
by a Certified Tumor Registrar (CTR) in a timely
manner (90 percent of cases are abstracted within
six months of the date of first contact with the
program). The standards also present mandated
follow-up rates of 80 percent for all patients
and 90 percent for recent patients, as well as
requirements for data quality and submission to
the National Cancer Data Base (NCDB).
The high quality data ensured by this governance
improves reimbursement and reduces costs,
particularly in an accountable care environment.
So, consider who is in charge of collecting the
data. Cancer registry data is collected by highly
trained Certified Tumor Registrars who have met
increasingly strenuous educational requirements,
including passing a national certification exam.
The CTR certification marks its 30th anniversary in
2013, a testament to the stability and long-term
contributions of these highly trained professionals.
Once the certification is obtained, registrars must
meet continuing education requirements to
maintain the CTR credential. CTRs are trained to:
“...correctly interpret and code cancer
diagnosis, stage, treatment, and outcomes
information for each case...” ii
The use of CTRs for data abstraction ensures that
cancer registry data is of the highest quality and
executives can trust the data as a reliable source
for informed decision making and utilize it to assist
in meeting quality parameters in multiple settings.
Value of the cancer registry
to the bottom line
Executives should understand what data their
cancer registry contains and how that data can
be easily extracted and used to help patients
and improve the organization’s bottom line. Since
data quality directly impacts patient outcomes,
the heightened quality of data housed in cancer
registries can deliver a positive impact on efforts to
reduce costs and improve reimbursement.
The cancer registry should already be positioned
to help the organization, because it can efficiently
provide all required outcomes data. Unfortunately,
many organizations mistakenly overlook the
cancer registry as a quality data source and
waste extensive time and resources by recreating
much of the same data.
Beyond outcomes data, the cancer registry can be
used to determine outbound and inbound patient
referrals, which can provide an accurate assessment
of both lost and realized opportunity. For example, if
the organization has referred numerous patients to
a nearby breast surgeon for appropriate treatment,
then perhaps the organization should consider hiring
a breast surgeon. This could help ensure that the
patient can receive treatment with the organization
managing their care. Similarly, if the cancer registry
data shows numerous inbound referrals for specific
treatments, there may be an opportunity to expand
this part of the organization to ensure effective, timely
treatment for patients.
By taking simple steps today, including asking a few
simple questions to assess the current state of the
cancer registry, the already impressive quality of
cancer registry data can be further improved, along
with its impact on tomorrow’s bottom line.
Cancer registry now the definitive
source for cancer outcomes data
The cancer registry exists as the timeliest, most
complete and most accurate data source for most
accredited cancer programs and should be every
executive’s preferred source for all cancer-related
outcomes data. Revised in 2012, the ACoS CoC
standards shifted the focus of the standards to the
quality of patient care and enhanced the reporting
of cancer data to include concurrent abstracting
options with the introduction of the Rapid Quality
Reporting System i i i (RQRS).
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4. Cancer registry now...
(cont’d)
Prior to the institution of the RQRS, providers
received information 18-24 months after treatment
rendering the treatment information insufficient
to assess quality of care. To address these issues
the CoC adopted the RQRS. Currently voluntary,
RQRS could become mandatory in the future,
which would require accredited cancer programs
to report data on patients concurrently and notify
hospitals of treatment expectations. Each hospital
would then receive its year-to-date concordance
rate relative to other similar hospitals at the local,
state and national levels.
The CoC has a data use agreement in place
to use the clinical information provided by the
RQRS for the purposes of quality review and
improvement. The revised CoC standards
assist hospitals with health care operations,
including quality assurance, utilization review and
accreditation. As a result, the cancer registry now
provides the most accurate and complete source
of data on cancer treatment and outcomes
available to many health care executives.
to reduce costs and improve patient outcomes
and organizational performance already exists
in the cancer registry. Beyond accessing existing
data, new fields can be added to the cancer
registry data collection process to ensure that
any additional required data is accessible
moving forward.
Simple steps today, financial
rewards tomorrow
The cancer registry data assessment will help
executives better understand the current state
of their organizations’ cancer registry and what
cancer registry data can do for their organizations
today. With a solid understanding of the starting
point in hand, executives should take the following
steps to further enhance the usefulness and future
potential of the cancer registry to improve an
organization’s performance in a variety of ways.
1 Develop standard reports for data analysis.
Quickly assess the organization’s
cancer registry data
To quickly assess the quality of an organization’s
cancer registry data and its potential to boost
organizational performance today, executives
should work with their teams to answer four
simple questions:
2 (Executives) Become active and involved in
cancer committee meetings where these
reports can be presented.
1 What data do we currently have access to
through the cancer registry?
2 What data has been required in the past and
is it relevant for use today?
Decisions on program development and
improvement can be made given your active
involvement in both data analysis review and
cancer committee attendance.
3 Ask for data.
3 What data is needed today in light of new
accountability and reporting standards?
Executives are often surprised to discover the
amount of data available to them that can
aid in their decision making processes.
4 Before conducting a study or chart review on
4 What, if any, additional data points should we
cancer care, seek out the assistance of your
cancer registry.
begin collecting to strengthen the registry’s
stature as a tool to build the bottom line?
As executives answer these questions, it should
become obvious that much of the data they need
These reports can be custom designed on
any data parameter collected by the cancer
registry and can aid in understanding the
who, what, when, where, why and how of an
organization’s cancer program.
Duplication of effort can be avoided, and
many resources can be applied to other
more useful efforts.
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5. Simple steps today...
(cont’d)
5 Monitor timeliness of treatment.
If the average delay between diagnosis
and the start of treatment is extended, it
could signal a communications breakdown
between specialties or a shortage of
appointment openings for treatment, and this
could be an opportunity for a fast tracking
program.
6 Monitor the treatment mix for the
primary facilities.
Does the treatment mix mirror national trends?
If not, it could mean that patients aren’t
being informed of all their options before
deciding on a course of treatment; perhaps
there is a need for a more thorough patient
consultation program.
7 Examine average stage of disease
at diagnosis.
Are the organization’s patients being
diagnosed at later stages of disease than the
benchmarks established at the local, state,
or national level? If so, the community may
need an early screening program to provide
patients and primary care physicians with a
better education on early detection.
9 Analyze the success of signature services.
Using rapid reporting mechanisms such as
the RQRS, executives can compare patients
who are eligible for signature services to those
who are using them to determine whether the
services should be grown (marketed, referred
and staffed) or discontinued.
10 Review patient addresses.
References:
i
Determine the primary age groups of patients
and compare them to previous data to see if
the average age has changed. This will help
in planning and scheduling support programs
for different patient age groups.
Commission on Cancer. Cancer Program Standards
2012: Ensuring Patient-Centered Care. American
College of Surgeons. http://www.facs.org/cancer/
coc/programstandards2012.pdf. Published
September, 2012. Accessed May 20, 2013.
ii
Commission on Cancer. Cancer Program Standards
2012: Ensuring Patient-Centered Care. American
College of Surgeons. http://www.facs.org/cancer/
coc/programstandards2012.pdf. Published
September, 2012. Accessed May 20, 2013.
iii
Commission on Cancer. The Rapid Quality
Reporting System. American College of Surgeons.
http://www.facs.org/cancer/ncdb/rqrs0509.pdf
Published April, 2009. Accessed May 20, 2013.
8 Monitor patient ages.
By taking a close look at patient addresses,
the organization can identify areas where
few or no patients reside, potentially signaling
an opportunity for extended community and
primary care physician outreach.
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6. About the Author
Laurie Hebert, RHIA, CCS, CCS-P CTR
,
Vice President and General Manager, Cancer Registry Services
800-458-3544, ext. 161
lhebert@care-communications.com
www.carecommunications.com/cancer_registry
As Vice President and General Manager, Cancer Registry Services at
Care Communications, Inc., Laurie Hebert is responsible for managing
client relationships, cancer registry consultants, and sales of cancer
registry services. Hebert also provides input and required oversight for
research projects that require cancer registry data. With over 20 years
of experience, Hebert has worked at various hospitals and cancer
registry facilities in a wide range of health information management
(HIM) roles.
She has published or contributed to many articles noted in national
trade publications, authored white papers related to the cancer
registry field, co-authored a study on pediatric lymphoma, and
assisted in the development of a pediatric staging form chosen by the
American College of Surgeons Commission on Cancer as a best practice tool for pediatric facilities.
Hebert is currently serving on the National Cancer Registrars Association’s (NCRA) Board of Directors as
Advocacy and Technical Practice Director-Midwest along with serving on several additional NCRA related
committees, and is the past chair of the association’s National Cancer Registrars Week Committee. She is
past president-elect of the Central Louisiana Health Information Management Association and past president
of the Southeast Louisiana Health Information Management Association.
Hebert is a member of several health care associations including the American Health Information
Management Association (AHIMA), National Cancer Registrars Association, Louisiana Health Information
Management Association (LHIMA), the Southwest Louisiana Health Information Management Association
(SWLHIMA) and the Louisiana Cancer Registrars Association (LCRA).
She received a bachelor’s degree in psychology and HIM from the University of Southwestern Louisiana.
Areas of Expertise:
l
Cancer registry regulations and accreditation
l
Cancer registry education and advocacy
l
Data management and analysis
l
Quality data collection
l
Cancer studies
l
Outcomes measurement
l
Database outcomes improvement
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