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Stem Cell Transplant: Making it all Work The Sarah Cannon Cancer Center Experience. Rocky Billups, RN, MS Administrator, Sarah Cannon Cancer Center The Workshop for Financial Coordinators The Transplant Financial Coordinators Association October 1-3, 2008 Nashville, Tennessee.
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The Sarah Cannon Cancer Center Experience
Rocky Billups, RN, MS
Administrator, Sarah Cannon Cancer Center
The Workshop for Financial Coordinators
The Transplant Financial Coordinators Association
October 1-3, 2008
Sarah Cannon Blood and Marrow Transplant Program
Stem Cell Transplantation and Research Program
Rocky Mountain Blood & Marrow Transplant Program
Texas Transplant Institute
Since 1982, we have performed over 5,000 Transplants
The Toughest requirement for a New BMT Program to achieve status as a Payor’s Center of Excellence Within their Transplant Network.
Volume, Volume, Volume
Its difficult to obtain the volume needed to meet the requirements when Payors deny you the approval to transplant their patient.
Cigna’s LIFESOURCE Transplant Network
Each facility in our network is carefully chosen and must continue to meet our stringent quality standards. We assess several factors, including:
-staff training and experience;
-number of transplants performed;
-availability of housing arrangements and transportation;
-geographic location and accessibility
United Resource Network
“Our BMT programs are selected through a process of quality measurement and value-driven contracting that are unique in the health care industry.”
“TRS contracts address 100% of the total transplant risk (similar services control only 60%). We cover all phases of patient health care from evaluation, pre-transplant, transplant, post-transplant and 12-month follow-up health care.”
“Because blood/marrow data is not tracked by the Federal Government, U.R.N. is arguably the only institution with enough data to manage the quality, selection criteria conformance and cost of this expensive (more than $300,000 average billed charges) and complex clinical event.”
An RFI is required annually by all Payors.
It reports the transplant center’s information and
The standardized RFI form in three parts:
1. Administrative Survey
2. Program Information
3. Outcomes Data
Foundation for Accreditation of Cellular Therapy
-Payors require BMT Programs to be Accredited
-Requirements for Accreditation
1. Volume of Autologous and Allogeneic BMTs
2. Structured Quality Management Program
3. Meet all standards within 3 sections of Survey
-162 Facilities in the United States and Canada
are FACT Accredited
-Payors want to know if a program is accredited, if not where are they in the process
-Payors consider FACT accreditation as a stamp of quality approval
-We structured our program based on the FACT standards
-It took us 1 year to write SOPs and implement the FACT standards into our program prior to performing our first BMT
-We were surveyed on Sept 5, 2008
The financial coordinator role may vary from
program to program.
Typically the Financial Coordinator works with BMT patients to ensure smooth coordination with their health insurance provider as well as assisting patients with any financial needs they may have.
In a new BMT program the financial coordinator needs to work with the Administrator, Physicians and other members of the team to develop
1. A List of Insurance companies and their contact
2. Process for communicating Approval Status
3. A process for Patient Financial Counseling
In a new BMT program the financial coordinator needs to work with the Administrator, Physicians and other members of the team to develop (cont.)
4. Process for informing all members of the team
the inclusion and exclusions of each Payor’s
5. Process for tracking all charges associated with
each patient’s transplant.
The Financial Coordinator has been the first line of defense to determine if we are eligible to transplant our patients
When a patient is referred to the program, the Financial Coordinator checked the insurance benefits to determine if the patient should be referred to another program.
As a new program we did not want to place more work on our referring physicians.
Due to our Program Structure we have 2 Financial Coordinators.
They work closely together to ensure the continuum of care for each patient as they navigate the program
The Financial Coordinators meet frequently to discuss insurance issues and review these issues with the BMT Coordinators