Expert Oncology Consulting Results
We are proud of what we've accomplished for our clients, and we invite you to take a look at some of our successful projects.
A cancer program wanted a review of the infusion billing and collections process.
Challenge: The cancer program is based at a community hospital with four medical oncologists. The business office did not meet with the cancer center leadership on a consistent basis to discuss denials or any issues about the revenue cycle process.
A recent change in cancer center leadership provided an opportunity to engage an outside expert to review 100% of the last 12 months of claims and payments for patients treated in the infusion center. The Oncology Group’s Revenue Recovery Review identified the following:
- Over $800,000 in missed charges
- Over $1,000,000 in underpayments by a commercial payer
- Large commercial payer had system issues with how certain claims were being processed
- Experienced certified coder made errors that caused underpayments
- Turnover, insufficient training and a lack of communication all contributed to lost charges and underpayments
A region’s largest community medical center and a key clinical research base for the area's only NCI-designated Cancer Center.
Challenge: Position the community medical center as a clinical research partner with an NCI-designated Cancer Center; facilitate a collaborative relationship to achieve the university's academic, funding and research goals while sustaining the community hospital’s patient volumes, private physician practices and market prominence.
This region’s geographic location, historic cultural cordiality, and acknowledged market symbiosis enabled all participants — as well as the consultants and those on the Board — to commit to a higher level of community-academic integration and leadership collaboration. The engagement included accommodating two cancer center facilities, access to community clinical practice patients, and highly charged local politics. During the engagement, The Oncology Group:
- Conducted several leadership summits assisting community hospital leaders in understanding and working with NCI mandates for academic cancer centers
- Positioned community medical center and academic center leaders to negotiate and create a community-wide clinical research collaboration
- Enabled the community hospital to successfully compete for NCI selection as an NCCCP site, furthering the region’s alignment with long-term NCI goals and programs
Western resort community with limited, but growing, single modality oncology care services.
Challenge: Create a sustainable cancer services model in a small rural hospital with limited patient volume. Provide patients access to medical oncology and surgical care without extensive travel.
This healthcare institution provides a venue for two cancer care modalities – medical oncology and surgery. The medical center also operates breast imaging services including digital mammography and diagnostic ultrasound. Physician and administrative leaders sought to create a more cohesive service line approach to cancer care that better integrated all oncology care providers. To achieve these broad objectives, The Oncology Group recommended leaders:
- Create a cancer care service line infrastructure
- Create an integrated patient experience to encompass all providers, which included multidisciplinary treatment planning with physicians in the key urban referral center
- Provide a "cancer care home" at the client institution
- Market the integrated oncology solutions within the rural/remote primary service area
Southern suburban community hospital with a statewide NCI-sponsored clinical research endeavor, competing with a nearby larger urban cancer program.
Challenge: Assist leaders in this sophisticated, large volume cancer program – located in a smaller southern town – to expand its geographic reach within the region. The client operated within a newly built cancer center facility, with ties to a NCI-designated Comprehensive Cancer Center, several other academic institutions, and a robust clinical research initiative. Their primary competition is a nearby city institution with an active oncology program.
Cancer program leaders, both physicians and administrators had successfully raised funds to create a show-stopper cancer center, in which two modalities operated through private practices. Leaders had developed a dynamic clinical research program and had robust referral relationships that provided four-figure analytic case volumes. The Oncology Group designed a series of small group participatory planning sessions, supplemented by a "Briefing Book" for each Steering Committee member. The Briefing Book contained relevant data, benchmarks, academic research, as well as planning models to ensure each participant was fully informed during planning sessions. Together the planning team:
- Validated and analyzed market data
- Aligned goals that united key private practice physicians and the hospital cancer program
- Developed a strategic business plan that included partnership and academic affiliations, an integrated cancer services infrastructure and tumor-specific growth strategies
A religious-affiliated oncology system in the Northern Midwest, with three hospitals operating as a single cancer program.
Challenge: This religious-affiliated system included a large sophisticated urban hospital in a rust-belt city, a smaller urban hospital – bifurcated by a river and bridge - in a distinct neighborhood within the same city, and a newly constructed small hospital in a growing suburban location with no cancer program. Leaders first engaged The Oncology Group to assist them with developing a strategic vision and plan for cancer services to encompass all three institutions.
After completing this initial engagement, the same client called on TOG for two additional quick-succession projects. The healthcare system was interested in building a cancer center. The large urban hospital operated a sophisticated oncology program which includes BMT services; the other urban-based institution was smaller, but had also operated an ACoS-accredited hospital for a decade. However, both these institutions faced declining patient volumes for all services. The newer hospital was experiencing explosive patient volume growth, was located in an up-and-coming suburban region, but had no cancer care services, affiliated oncologists, nor radiation therapy equipment. Leaders called on The Oncology Group to:
- Evaluate the current cancer patient base (volumes and revenues)
- Assess the regional market, including competitors’ services and volumes
- Define a vision and ideal continuum of cancer care for the system
- Provide free-standing cancer center facility size and location expertise
- Provide decision guidance and services to integrate information channels
- Provide site selection criteria and accompanying cancer center leaders to location evaluations
Several engagements later, the healthcare system opened its new oncology center in the suburban location. The center is flourishing, and patient volumes and revenues continue to grow.
East Coast NCI-designated Comprehensive Cancer Center
Challenge: This venerable institution engaged in an extensive review of its cancer center operations and performance, including a competitor analysis, a market-share analysis, and an evaluation of referral relationships.
After several decades of NCI-designation, leaders began a strategic planning process to develop defined programs to improve their market position, structure, organization and operations. Goals were to:
- Position their comprehensive cancer center as a world-class international leader in both oncology research and cancer care
- Increase regional market share by developing a successful outreach research network to engage community physicians
- Improve the overall cancer patient experience by upgrading their convenience and service delivery amenities
The Oncology Group assisted leaders to develop functional small working groups that addressed two sectors – Business and Governance issues and Clinical Services Delivery issues. The Oncology Group planned and facilitated these working sessions. The meetings were all-encompassing as participants discussed and made decisions about how to achieve unanimity of purpose (embracing the cancer center and the sponsoring University SOM); the role of community-based oncologists within the academic cancer center; business and enterprise issues (e.g. billing and collection operations); addressing patient experience and amenity dissatisfactions; as well as new infrastructure options and business realities. This NCI-designated Comprehensive Cancer Center enacted many of the decisions and operates today with a clinical research network that includes a number of the state's community-based oncologists. The university program recently opened its new cancer center replete with patient satisfying amenities.