R E S ammography O U M R C E dvantage K A I T J © athway u n P e 2 HANYS BREAST CANCER DEMONSTRATION PROJECT™ 0 Healthcare Association of New York State One Empire Drive, Rensselaer, NY 12144 0 (518) 431-7600 ✦ www.hanys.org 3 TABLE OF CONTENTS The MAP: Mammography Advantage Pathway Resource Kit© ofTable Contents consists of the following components, which also are available online at www.hanys.org/quality_index/Breast_Cancer_Project/resourcekits.htm. Preface Statement by Rhonda Mealor, Principal, Oncology Solutions, LLC. Introduction: What Can This Kit Do For You? Provides an overview of the Resource Kit. HANYS BCDP Advisory Board Members Additional Resource Kits Available: Breast Health Patient Navigator Program Resource Kit© and Provider Tools for Bridging the Gap: A Resource Kit for Helping Newly Diagnosed Breast Cancer Patients© Thumbnail sketches and a Web link to two other resource kits developed by the HANYS BCDP™. MAP Self-Assessment Tool Self-administered data collection instrument specific to financial, clinical, and service areas of mammography care. Coding Resource Tools Samples you may wish to adapt to your organization. ■ Common Breast Cancer Screening, Detection, and Treatment Coding Guidelines ■ CPT Utilization Description and Update ● Attachment A ■ Technical Fee Schedule Comparison ■ Sample Professional and Technical Breast Imaging and Procedures Encounter Form ■ Sample Professional Breast Imaging and Procedures Encounter Form ■ Sample Technical Breast Imaging and Procedures Encounter Form Financial Resource Tools Samples you may wish to adapt for your organization: ■ Sample Pre-Registration Checklist ■ Sample Financial Management Reports ● Productivity Summary by Month ● Radiologist Productivity Summary ● Radiologist Productivity by User continued... Breast Imaging Information Systems Vendor Comparisons Compares automated clinical information system capabilities. Mammography Equipment Resource Tools Compares mammography equipment and film capabilities. ■ Mammography Equipment Vendor Comparisons ■ Mammography Film Vendor Comparisons Patient Satisfaction Survey Resource Tools Evaluate patients’ perception of care. ■ Sample Patient Satisfaction Survey Forms: ● Breast Health Program Patient Satisfaction Survey ● Center for Women’s Health Satisfaction Survey ● Health Care Giver Report Card Patient Education Survey Resource Tool Evaluate patients’ perception of the benefit of health care information they receive. ■ Sample Patient Education Survey Physician Satisfaction Survey Resource Tool Evaluate physicians’ level of satisfaction with breast health services. ■ Sample Physician Satisfaction Survey MAP Flow Charts Graphical presentations of performance improvement processes, mammography process overview, and possible action items. ■ Performance Improvement Process Template—Financial/Service/Clinical Sample Templates: ● Financial ● Clinical ● Service ■ Theoretical Flow Charts ● Screening Mammography to Definitive Diagnosis: Theoretical Flow Chart and Process ● Screening Mammography: Theoretical Flow Chart and Process ● Diagnostic Mammography: Theoretical Flow Chart and Process ● Biopsy to Definitive Diagnosis: Theoretical Flow Chart and Process Using the MAP: Mammography Advantage Pathway Resource Kit© Microsoft® PowerPoint presentation to help you present the information contained in this book. Rationale and Supporting Research Resources and support for best practice process framework in mammography care. ■ Appendix A–Breast Imaging Reporting and Data System (BI-RADS®) Reporting Categories PREFACE Rhonda Mealor, Principal, Oncology Solutions, LLC Preface New York State boasts many favorable distinctions. Having the second highest incidence of breast cancer in the nation is not one of them. New technologies and techniques in breast cancer diagnosis and treatment have improved the prognosis for women with image-detected cancers.1 Yet, breast cancer continues to be the sec- ond leading cause of death in women. While this tragedy continues, the reimbursement for diagnostic breast services continues to decline and the struggle to manage the enormous respon- sibilities of a breast center becomes increasingly difficult. However, with sound knowledge, incisive thinking, and perseverance, hospitals, physicians, and health care professionals can work collaboratively to positively affect the screening, detection, and diagnosis process for individuals in their communities. The MAP: Mammography Advantage Pathway Resource Kit, developed by the Healthcare Association of New York State Breast Cancer Demonstration ProjectTM in conjunction with Oncology Solutions, LLC, can help. Facility Self-Assessment The MAP: Mammography Advantage Pathway Resource Kit© and the MAP Self-Assessment Tool were developed after extensive work, including wide-ranging surveys and on-site interviews, with four very generous demonstration hospitals. The MAP Self-Assessment Tool helps health care teams to: ■ perform a self-assessment of mammography services from the point of screening to the point of definitive diagnosis; ■ measure levels of financial, clinical, and service efficiencies for mammography services; ■ identify areas for improvement; ■ stimulate an internal review regarding current processes in breast care; and ■ open dialogue among staff within and between departments. This Resource Kit is designed to ensure that any change hospitals incorporate will lead toward a more standard approach to service, clinical, and financial processes. It provides the background and resource data needed to base changes on a solid foundation of information. Three indica- tors—service, clinical, and financial—were used in the development of this Resource Kit. Because many of the indicators are not “black and white,” a range of regulations, benchmarks, and Oncology Solutions’ suggestions are also provided. Clinical Performance Improvement Any proposed change must be implemented carefully. The Performance Improvement Process Template contained in this kit provides a model for successfully managing change. The most important element is to engage those who are involved in the clinical process. Many stake- holders throughout the hospital will be interested in shaping any performance improvement - 1 - initiative. The MAP kit provides samples of how to use the Performance Improvement Process Template, as well as flow charts that pictorially define the process from initial patient contact, to suspicious findings, to diagnosis. Financial Processes The Financial Resource Tools section of this Resource Kit can help hospitals and health systems strengthen the finances of their breast health centers. The financial picture is often bleak for breast health centers. Even as breast centers focus on the clinical aspects of care, negative finan- cial returns threaten the ability to continue providing care. By collaborating with the finance team, outpatient registration personnel, and others in the hospital, managers, physicians, and technologists can enhance the financial performance of their breast health centers. The first step is to understand the current situation. It is important to work with the hospital’s finance team to determine how charges are created, how often are they updated, and who is responsible for researching coding and related billing changes. From the time the patient first registers into the system, there is opportunity for errors that can affect the entire process. Implementation of a clearly defined, accountable process is critical to a financially viable program. This kit provides encounter forms covering services and codes. Charge capture and appropriate coding are two areas of opportunity that are often missed in a breast center. This MAP kit includes Common Breast Cancer Screening, Detection, and Treatment Coding Guidelines, which allow the team to review the Correct Coding Initiative for these situations. Incorrect coding is a recur- ring issue that can substantially affect a breast health center’s financial standing. The Resource Kit also includes fee schedules that detail the unadjusted Medicare fee and the 50th, 75th, and 90th percentiles. For example, the amount listed in the 50th percentile column repre- sents the 50th percentile of usual, customary, and reasonable fees for the specific service or pro- cedure. The 50th percentile is that point where 50% of fees for a given procedure are at or below the amount listed and 50% are higher than the amount listed. These fee schedules allow the health care team to compare the facility’s performance with others throughout the nation. Service and Patient Satisfaction The patient satisfaction surveys included in this kit can be used to foster change. Whether work- ing with patients or with the physicians who refer patients, understanding patient satisfaction can provide a clearer direction for identifying issues, determining solutions, and implementing action plans. As consumers continue to be empowered to make decisions about where to go and where to stay for health care, satisfaction surveys will continue to grow in importance. Positive Change My staff and I were extremely pleased and fortunate to have the opportunity to be a small part of this project. There are those rare cases as a consultant when you absolutely know you have had the opportunity to influence positive change in the ongoing struggle against cancer. This has been one of those times for Oncology Solutions. Rhonda Mealor is a Principal of Oncology Solutions, LLC, with over 17 years experience in oncology consulting. She has assisted