Dr. Patch Adams, the real person behind the hit movie "Patch Adams," starring Robin Williams.

Patch is both a medical doctor and a clown...but he is also a social activist who has devoted 30 years to changing America's healthcare system, a system which he describes as expensive and elitist.

He believes that laughter, joy and creativity are an integral part of the healing process and therefore true health care must incorporate such life. Doctors and patients in his model relate to each other on the basis of mutual trust, and patients receive plenty of time from their doctors. Allopathic doctors and practitioners of alternative medicine will work side by side. If you think that all sounds like a utopian impossibility, it isn't. Patch and his colleagues practiced medicine at the Gesundheit Institute together in West Virgina that way for 12 years in what he calls their "pilot project." They saw 15,000 patients. Patch Adams has devoted his life to the study of what makes people happy.

The Institute addresses, by action, four major issues in health care delivery: the rising cost of care, dehumanization of medicine, malpractice suits, and abuses of third-party insurance system.

Dr. Adams adds to his training as a physician, his experience as a street clown. In working with health and mental health professionals, he explores the relationship between humor and therapy using his unique blend of knowledge, showmanship and "hands on" teaching techniques. Says Dr. Adams, "I interpret my experience in life as being happy. I want, as a doctor, to say it does matter to your health to be happy. It may be the most important health factor in your life."

Edward G. Shaw, MD, is Professor and Chairman of the Department of Radiation Oncology at the Wake Forest University (WFU) School of Medicine in Winston-Salem, NC. He is a nationally and internationally expert in the radiotherapeutic management of central nervous system tumors in adults and children, symptom management and quality of life in cancer patients, and complementary and alternative medicine in oncology, particularly botanical and natural products.

Dr. Shaw received his undergraduate degree from the University of Iowa (Iowa City, IA) in 1979, MD from Rush Medical College (Chicago, IL) in 1983, followed by internship and a residency in radiation oncology at the Mayo Clinic (Rochester, MN) completed in 1987. After 8 years on faculty at Mayo, Dr. Shaw moved to Wake Forest in 1995 where in addition to chairing Radiation Oncology, he serves as Director of the Cancer Center's Clinical Research Program.

Dr. Shaw is a veteran of clinical oncology research. He has been principal investigator (PI) or co-PI of 35 clinical trials which have accrued >2500 patients in brain tumors, lung cancer, and symptom management including investigator-initiated studies at Mayo and Wake Forest as well as in the North Central Cancer Treatment Group, Radiation Therapy Oncology Group, and New Approaches to Brain Tumor Therapy.

Dr. Shaw has published 126 journal articles, 99 abstracts, 23 book chapters, and one book over the last 20 years. He serves on the editorial boards of the Journal of Clinical Oncology, International Journal of Radiation Oncology, Biology, and Physics, and Neuro-Oncology. Dr. Shaw is PI of Wake Forest's Community Clinical Oncology Program (CCOP) Research Base, a $6 million dollar (direct costs) 5 year National Cancer Institute / Department of Cancer Prevention grant which allows Wake Forest's cancer treatment, control, and prevention studies to be performed by nearly 100 community cancer centers that are part of 12 CCOPs across the United States. He and his wife Rebecca have three adult daughters and enjoy family time, travel, and the outdoors.

Updating a radiation oncology department having outdated planning systems and 14-year old treatment delivery machines does not occur without some surprises. Administration's expectation for program growth, machine ROI, and programmatic goals must be harmonized with clinical commissioning timetables, staff training, and QA/patient safety concerns. Business planning based on patient volume and billings was used on a discounted cash flow model against the outlay of capital expenditures. Algorithm used was Patient Volume x Billable Charges = Gross Revenue (V x C = R). Results did not follow the original business plan assumptions as IGRT treatment times were longer and clinic workflow changed. Hence, pricing and contracting had to be re-examined, and the need for larger amounts of digital storage than anticipated materialized quickly. Today 50% of our treatments are IGRT. Patient volume alone is not adequate; treatment complexity must be incorporated into the business model. Solid contingency planning is essential.

#004 Improving Productivity and Clinical Quality Utilizing the EMR, Clinical Indicators and Benchmarks
Teresa McKay

Once you have implemented an electronic medical record the rewards are great. This presentation will share the West Michigan Cancer Center's experience in maximizing the real benefits of an electronic medical record utilizing its rich database to track and monitor ASTRO, ASCO, CMS and departmental quality indicators with the goal to ultimately improve clinical outcomes. Further, how the electronic medical record allows for a compressed patient throughput schedule which allows for high volumes if demand warrants will be shared. Finally, the presentation will roll up in a scorecard outling the benchmarks utilized at the West Michigan Cancer Center for staff productivity, patient satisfaction, referring physician satisfaction, financial indicators, and clinical quality indicators.

#005 Documentation and Coding 101
Deborah Churchill, RTT

This session will provide an introductory level overview of the codes that result for a standard treatment regimen in radiation oncology. This presentation will follow the patient presentation process, beginning with the consult and continuing through the completion of treatment.

The documentation and utilization guidelines will be presented for each code as it is discussed. As the encounter process is summarized, a sample composite coding summary will be demonstrated. Two parallel grids will illustrate the coding referencing the associated documentation that is required for the entire course. This will provide the attendee with a summary of the customary codes and required documentation for a standard treatment course.

This talk will include a puzzle (wheel of fortune style) where a corresponding letter for the puzzle will be revealed as each code is discussed. The audience will be asked to guess the puzzle, which will result in a prize for the first correct answer!

#006 Funding Technology
Nick Hernandez

Radiation Oncology facilities often find themselves trying to keep pace with advancements in technology, but keeping up is easier said than done. Investment in technology is placing heavy demands on the scarce capital resources available. As a result, administrators are exploring alternative sources of capital beyond traditional bank loans and bond financings. Many administrators are taking a fresh look at lease financing and are raising some significant questions.

Radiation oncology administrators should know what leasing options are available and when leasing is an appropriate solution. They should know what business issues must be addressed in a leasing program and ultimately how leasing might affect their organization's credit position.

This session has been among the most popular interactive sessions at the SROA Annual meeting. The distinguished panel of experts will provide an update on recent billing and reimbursement issues and developments. Then, the audience will have an opportunity to ask questions. Don't miss this enlightening, lively discussion.

Jay Loeffler, MD, current chief of MGH Radiation Oncology. Loeffler began his career with the Joint Center for Radiation Therapy at HMS in 1983 where he developed techniques to deliver focal, high-dose radiation for brain and skull base tumors. In 1996, he joined MGH Radiation Oncology as medical director of the service that became the Northeast Proton Therapy Center. He has expanded those treatments and is a world leader in the field of neuro-oncology. In 2000, Loeffler was named chief of MGH Radiation Oncology and the Andres Soriano Professorship of Radiation Oncology.

Julia Rowland, PhD, was appointed director of NCI's Office of Cancer Survivorship in September 1999. Before coming to DCCPS, she was the founding director of the Psycho-oncology Program at the Lombardi Cancer Center at Georgetown University (1990- 1999). Prior to that, she trained and worked for 13 years in psycho-oncology at Memorial Sloan-Kettering Cancer Center (MSKCC). Dr. Rowland received her PhD in developmental psychology from Columbia University in 1984 and was one of the first two post-doctoral fellows at MSKCC to receive NIH-supported training in the then newly emergent field of psychosocial oncology. While at MSKCC, where she held joint appointments in pediatrics and neurology, Dr. Rowland helped establish and was the first director of the Post-treatment Resource Program.

Her research has focused on both pediatric and adult cancer survivorship. She has published extensively on women's reactions to breast cancer, as well as on the roles of coping, social support, and developmental stage in a patient's adaptation to cancer and co-edited the groundbreaking text, Handbook of Psychooncology: Psychological Care of the Patient with Cancer (1989). She is also a frequent speaker to both lay and professional audiences on issues related to quality of life and health after cancer.

Dr. Rowland is a member of several advisory boards, including that of the National Coalition for Cancer Survivorship and the American Psychosocial Oncology Society. Her service on journal editorial boards includes being past editor of the survivorship department for Cancer Investigation, and contributing editor for Breast Diseases: A Yearbook Quarterly. Since joining the NCI, Dr. Rowland has helped build the size and visibility of the Office of Cancer Survivorship and championed partnerships with diverse federal and non-governmental agencies to advance public awareness about the needs of survivors. In 2006, Dr. Rowland was recognized for her leadership role in and contributions to the larger field of psycho-oncology with Fellow status in the Society of Behavioral Medicine and the American Psychological Association's Division 38, Health Psychology.

Mitch Latinkic is a division administrator for the Division of Radiation Oncology. Latinkic had helped establish the first hospital-based proton therapy center in the United States at Loma Linda University Medical Center in California before settling in M.D. Anderson.

This session will identify radiation therapy services that fall under the definition of "stereotactic," including cranial versus extracranial, robotic treatment,single fraction and fractionated stereotactic procedures.

Procedure codes applied to identify these stereotactic procedures will be reviewed in detail, as well as medical necessity and other key elements that should be included in the medical record to support the selection of this treatment modality. There are Level II HCPCS codes reported for hospital radiosurgery, specific CPT® codes for stereotactic body radiotherapy and other unique coding scenarios not found in standard external beam treatment.

In addition, the application of bundling guidelines, placement of fiducially markers for stereotactic treatment and other related issues will be reviewed in this fast-paced, informative session!

#014 Virtual Images: How to Monitor Physician Review of Electronic Portal Images
Diane Cassels. Kelli Gress, Tim Crenshaw

About 12 months ago, the Emory Department of Radiation Oncology chose "electronic portal image" review as a quality improvement project. The aim of the project was to achieve 80 percent compliance on a weekly basis of EPI approval with no unchecked images older than ten days.

To accomplish this, a report of each physician's approval percentage was disseminated- non-blinded - on a weekly basis. Furthermore, the metric was included in each physician's incentive plan. Implementation of these two tests of change resulted in meeting the project goal. However, continued monitoring is necessary to sustain the improvement.

This process improvement project required the involvement of administration, the chief therapist and the chair of the department. Utilizing new reporting tools has decreased the amount of time spent in running this report on a weekly basis. Reporting to the physicians along with the peer pressure of meeting goals, has achieved the desired effect.

#015 Beyond Quality and Safety: Creating an Exceptional Patient Experience
Paul Ortiz & Kim Collins

Today's economy is driven by the consumer's expectation of a unique experience. Healthcare institutions that wish to lead must embrace this concept in order to remain market competitive. The Methodist Hospital has adopted the "Patient Experience — Personal Pathways" as their tool for developing a unique experience for our consumer, the patient. The approach discovers the important differences of each of our patients and tailors their daily visit by providing an experience unique to their personal preferences. This presentation will provide the audience with an overview of the Radiation Oncology Department's development, implementation, challenges, success, and future for the Patient Experience program. By innovatively acting on the uniqueness of others, Methodist has become unique. Our own path to the future lies in the Personal Pathways we create for each one of our individual patients. This concept builds on the excellence many of us have achieved so far, but attests to the notion that we must reach beyond our current achievements.

#016 EMR: The How, The Why, And The ROI
Teresa McKay

The West Michigan Cancer Center has had an electronic medical record in place since 2004. We struggled with many obstacles and deterrents along the way. Through determination and teamwork, we successfully implemented a process to assure eventual implementation of an electronic medical record. This presentation will fully share our experience in converting to an electronic medical record application by application; share how we graded each software application, the ease or lack of ease of implementation and timeline for conversion. This presentation will also discuss our strategies for handling obstacles, the training necessary, and the hardware selected. Of particular interest to administrators in justifying such a major investment will be the immediate and projected return on this investment.

Industry experts anticipate that within the next five years, at least 10 new Proton Therapy facilities will open in the United States. With this growth, comes the need to learn more about this exciting technology. This presentation will provide a general overview of Proton Therapy accelerator systems, including: a brief review of the history of particle therapy accelerator development; a review of clinical benefits and disease sites commonly treated with Proton Therapy; and an overview of proton accelerator systems configuration in existing and under construction Proton Therapy centers in the United States, as well as system configurations available to consider in development of future Proton Therapy center development.

#018 2008 National Patient Safety Goals: How to Ensure Compliance in Radiation Oncology
Terror Ragland

Beginning in 2003, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) established the National Patient Safety Goals (NPSG). The purpose of these goals is to promote specific improvements in patient safety. Acceptance of and compliance to these NPSGs has been embraced in JCAHO accredited hospitals. As with most new implementation measures in hospitals, initial efforts are directed at in-patient departments. Only now is the impact of these NPSGs being felt in Radiation Oncology departments. The most pertinent of the NPSGs to Radiation Oncology is the Universal Protocol to prevent wrong site, wrong procedure, and wrong person treatment. This presentation will discuss how Northside Hospital Cancer Center addresses each of the requirements for compliance with the Universal Protocol. Participants will see clinical examples of compliance measures for both brachytherapy and external beam radiotherapy procedures.

#019 How do we pay for this? Capital Replacement/Expansion planning in an uncertain capital, reimbursement and regulatory environment
Brad Daniel

The pace of new technology continues to accelerate along with the demand for radiation oncology services. Offering state-of-the-art services requires near constant reinvestment in technology and facilities. At the same time, access to capital and reimbursement are under growing pressure. The familiar question to all radiation oncology administrators, "How do we pay for this?" is now more vexing than ever. This workshop will go beyond the traditional planning exercises to explore the process of selecting the appropriate expansion, defining the challenges, and creating the case to the audiences that will enable you to sell your case to not only the capital investors but to the third-party payers and public entities that will ensure your success.

#020 Legal Joint Ventures - Physician/Freestanding/Hospital
Sharon Swann & Ron DiGiamio

This session will cover different scenarios that are involved with the joint venture process. The session will cover the current hot items of urology and radiation oncology JVs in both the freestanding and hospital sessions. We will have a question and answer session to discuss the right time to consider joint ventures and possible return on investment comparisons showing the differences in hospital/freestanding payments in different locations around the country.

Hospitals, freestanding centers and physicians while treating cancer patients must keep current on all the changes affecting their ability to comply with regulations and retain their existing income. It is difficult for the providers to keep current in reimbursement and documentation issues. They depend upon consultants in the industry to supply them with the tools to ease the bureaucratic burden. In many instances the cancer centers are dependant upon internal mechanisms to keep them current and up to date but many times these systems fall short of their expectations. The discussion of current and future coding, documentation, and payments changes will be covered in this session. We will present to the physicians, staff and hospitals what the changes were in 200 and the probable changes in 2009.

#022 Bringing a Revolutionary Proton Beam Therapy System to a Community Cancer Center: A planning Study
Catherine Matthias

Proton beam therapy is widely considered a superior radiation treatment to conventional systems for its tissue-sparing abilities, but has not been widely adopted due to the significant capital commitment required for the technology (over $100 million). A more affordable proton system design is under development by Still River Systems, Inc. that reduces the equipment and implementation costs by using high-field superconducting magnets to reduce the accelerator size. Our cancer center will be among the first of five in the country to purchase and operate this revolutionary technology.

Financing, designing and constructing a highly customized vault, and finally planning for implementation and operation of the proton treatment system has become a top priority for the cancer center over the past year. This presentation will detail the creative financing arrangement for a $20 million project, innovative design and construction requirements for the customized vault and finally, preliminary plans for operating this technology.

#023 Clinical Results of a Medical Error Reduction/Compliance Software Program in Radiation Oncology
Ed Kline

Ensuring patient safety and compliance with regulations is a significant goal of radiation oncology centers. Over 50 percent of JCAHO standards are directly related to safety. JCAHO and CMS have jointly developed Hospital Quality Measures with hospital quality data (performance measures) tied to Medicare payments (hospital performance data available at www.medicare.gov, or by phone). This work describes the implementation and clinical results of a medical error reduction/compliance software program designed for reducing preventable systems-related medical errors (i.e., Sentinel events, "near misses") and violations of regulatory requirements (i.e., State/NRC) while ensuring compliance with recommended standards (i.e., JCAHO, ACR, ACRO, etc.) and charge capture/billing practices (i.e., CMS). Data collection and the analysis of errors/violations using this computerized software program at freestanding centers will be presented.

#024 Acuity of Treatment Regimen - Staffing Models
Judy Yarberry

The subject will be on Acuity of Radiation Therapy, Real time data from ARIA of beam on data and IGRT and Cone beam time considerations and how has it change the staffing models from the past, I can also sort the data as to if it is an IMRT IGRT or 3D and compare ICD-9 codes. That will provide department managers a method of supporting additional staff or decrease staffing on acuity of their data available in ARIA.

Radiation Oncology departments provide a critical service to patients, utilize the talents and time of numerous employees, and depend on physician referrals for their patient base. Each aspect - patient, staff, and physician - constitutes a "customer" of the Radiation Oncology environment. As in any other service line, customer satisfaction is a valuable indicator and can be used to benchmark Radiation Oncology departments.

In this presentation, we will explore how one community, not-for-profit hospital has used various tools (i.e. Press Ganey®, Gallup®, customized surveys) to evaluate and improve patient, staff, and physician satisfaction in its Radiation Oncology department. Specific methods and outcomes will be discussed regarding each aspect of customer service and satisfaction.

#026 Nonphysician Practitioners in Radiation Oncology
Cindy Parman

This session will include common definitions of nonphysician practitioners, services typically provided by these individuals, and current utilization in the field of radiation oncology. Existing urban legends regarding on-treatment visits, post therapy follow-up services and more will be discussed.

The Centers for Medicare and Medicaid Services (CMS) has published numerous documents regarding the use of NPPs in an 'incident to' capacity, and the Office of the Inspector General (OIG) has targeted 'incident to' billing for review in calendar year 2007. It is also important to remember that 'incident to' is a Medicare convention only, and other payors may or may not subscribe to this billing methodology.

The decision to hire a nonphysician practitioner generally requires significant front-end planning, and tips will be provided in this session to help the radiation oncology practice analyze the impact of a nonphysician on practice revenue.

#027 Proton Treatment Centers: The Strategic and Financial Benefits to Academic Medical Centers and Health Systems
Arnold Friede

Of the approximately 845,000 Americans who will be diagnosed with cancers each year, approximately 500,000 patients will likely undergo radiation therapy; experts estimate 175,000 to 200,000 patients would derive benefit from proton therapy.

Tumors in close proximity to radiosensitive organs derive particular benefit from proton therapy. For example, brain/CNS tumors are often in close proximity to the spinal cord, and even a small dose of stray radiation can have devastating long-term consequences.

New facilities will likely increase theoretical proton therapy capacity several-fold over the next five years. Nevertheless, even a tripling of theoretical capacity to 45,000 patients per annum would only provide treatment slots for 25% of the estimated proton therapy patients.

#028 Principles of Project Management for Radiation Oncology
Janet Brumfield

This presentation will identify the process used for project planning and management at Northside Hospital in Atlanta, GA during the past decade. The Participants will learn how to initiate a project and identify all the critical stakeholders, support departments, and milestones required for successful project completion. Participants will understand the process for ensuring project advancement and discover ways to kick-start stalled projects. Finally, the class will discuss specific methods for documenting the project successes and observe specific case studies that may be used in other facilities undergoing change. Although the focus of the presentation will be project planning and management for complex situations, the novice planner will learn basic planning principles to use for less complex projects.

The resurgence in employing specialists is occurring throughout health systems nationally. With significant cancer program growth and investments throughout the country, continued reimbursement pressures in medical oncology, and future uncertainty about radiation, medical, and surgical oncologists' reimbursement in light of the financial shortcomings of the Medicare program, the employment mechanism is increasingly the favored strategy for cancer programs and centers as they strive to maintain adequate complements of oncologists.

This session will provide a comprehensive review of useful tools, examples, and approaches to structure employment with oncologists to assure that the final arrangement is fair and equitable, contributes to physician practice and cancer program growth, and is consistent with fair market value principals.

#030 Coding Essentials for the Radiation Oncology Administrator
Sharon McKenzie

This session will include an overview of compliance coding for the Administrator, the methodology, internal process and the financial viability associated compliance coding.

Also discussed will be the importance of understanding coding terminology and reference materials to assist the Administrator. In addition, the session will include the importance of financial counselors, the 'best' patient registration process for assuring coding compliance.

#031 The Humanity of Patient Orientation in Radiation Oncology
Kimberly Young

There is too much information given to the patient at the time of consult. The patient leaves the department without a good grasp on the day-to-day treatment flow.

To create for the patient an environment of support, ease of access to care and consideration for personal dignity.

If a patient's apprehension and consequential stress can be allayed, their focus can turn to their own healing and renewal.

By impacting patient comfort and staff satisfaction, it will enable the Department of Radiation Oncology to become a true healing environment.

#032 Identifying Appropriate Levels of Employee Competency and Delegating Proof of Competency to Employees
Rajinder Singh

The process for defining employee competency has seen little change during the past decade. However, technological advances in Radiation Oncology during this same decade have been enormous. The use of old fashioned checklists for assessing and assuring competency are no longer adequate or appropriate with the complex technology used today. Specific treatment modalities are composed of numerous lock steps that cannot be assessed via a simple yes or no answer.

During this presentation, the participant will see examples of methods to identify initial employee competency. Participants will learn a process to identify which of the hundreds of initial competencies require ongoing assessment. Finally, participants will discover various methods employees may use to demonstrate annual competency, thereby shifting the onus of proving competency from the supervisor to the employee.

This program is designed to educate all Radiation Oncology staff of the importance of documentation and compliance. We will discuss why the appropriate documentation is necessary and the potential ramifications of not having it. We will also discuss who is responsible for all documentation in the medical record. Finally we will address where the appropriate documentation should be located in the paper record as well as the electronic record as you transition to an EMR.

#034 2008 Coding and Documentation Updates (Part 2 of ABC's of Radiation Oncology Billing)
Tamara Syverson & Kelli Weiss

This program is designed to educate administrators, managers, radiation therapists, dosimetrists, and other clinicians of the current coding and documentation updates for Radiation Oncology billing. This discussion will address 2008 rules and guidelines as documented by the Federal Register and provide instruction on how to locate this information as well as other coding and documentation guidelines available. We will also discuss advanced coding used for special procedures performed by our specialty, such as stereotactic and brachytherapy, as well as the supporting documentation for each procedure.

#035 Challenges of Image-Guided Radiation Therapy Billing/Coding
Jana Grienke

Even with proper coding, many payers are not accustomed to the newer IGRT technologies and require instruction from a Radiation Oncology professional to educate them when questions/denials arise regarding medical necessity and codes billed.

The newer technologies include, but are not limited to: MRI imaging as simulation, PET/CT imaging (both diagnostic and for simulation), IMRT, 4D Imaging/Delivery, HDR, and cone beam.

The appeals process will also be addressed with specific tools provided for aid in working denials from the re-determination level to the Administrative Law Judge level of appeals.

Documentation is key in proper compliance and examples will be revealed as well as suggested templates for appealing denials and for use in basic coding/charge capture support.

Lastly, communication techniques used when educating staff and referencing payers are an integral part in the billing process and will have a significant effect in reimbursement. Various techniques will be explored and examples provided.

#036 Billing Roadmaps for Radiation Oncology
Scott Phillips

Technological advances in the world of radiation oncology have made it difficult for billing personnel to keep track of changes in codes and clinical procedures. The lack of current documentation or charge capture leads to under billing and large losses of revenue to a practice, freestanding center, or hospital. Billing personnel can use roadmap information as a source of expected charges as well as charges that, although uncommon, would be acceptable and billable.

Dr. Wilson received his medical degree from the University of Missouri in 1965, and completed a residency in radiation oncology at the Penrose Cancer Hospital in Colorado in 1969. He joined the Medical College faculty in 1974, and has been Professor and Chair of Radiation Oncology since 1985.