Summary of the Midland Forum
MidMichigan Health, Board Room
11:30 am – 1:15 pm, April 16, 2014
Overview:
The Midland forum had 10 pre-registrations and an attendance of 10, including 1 from BCBSM and 1 from the Coordinating Center. The attendees, excluding BCBSM and the CC, were from MidMichigan Health (4), MidMichigan Physician’s Organization (1), East Central Oncology Associates (1), Midland Pathology Associates (1) and MidMichigan Collaborative Care Organization (1). While the number of participants was small, there was a nice mix of clinicians, physician organizations, a genetic counselors and a physician assistant.
Discussion Summary
1. How do you envision an advisory board working?
a. There is no one in this area that would have the breadth of expertise to serve on an advisory board – who will make up this board?
i. The participants could see that the consortium could provide some expert input as we go through the tests, but for the tests not being considered, finding adequate expertise may be difficult.
ii. The genetic counselors could provide some help with germline mutations, but not with the somatic mutations.
b. An advisory board of this type does not seem to be in scope with a quality improvement initiative and may represent a conflict of interest.
2. The Coordinating Center is considering hiring the data abstractors and assigning them to health systems – how would this work for your organization?
a. It would need to be brought to our IT leaders and the IRB board. They would have to make the determination as to whether or not this would work.
b. MidMichigan is currently participating in another CQI and has some data abstractors in place who may be able to be shared.
3. What are your greatest needs that the GTRQC may be able to help with?
a. The participants indicated that the GTRQC should take a look at BRCA, ALK, KRAS – focusing on breast, colon and lung cancers as those are the ones they deal with the most. Lynch Syndrome, some of the panels that are being used should also be considered.
b. There was a question as to what we would be defining as genetic testing – would IHC (immunohistochemistry) and MSI (microsatellite instability) be included in that?
i. Based on input received after the meeting, IHC is not technically in scope, but MSI sometimes does include molecular diagnostic testing and sometimes it is done simply with IHC. Looking at this to determine if the molecular diagnostics is bringing benefit to the patient may be something the GTRQC could look at.
c. The participants indicated that they needed assistance with guidelines for when tests should be ordered, who are the right patients for the tests, and who should be placing the orders for the testing. Currently, tests are being missed because people are unsure which physician should be placing the order, resulting in delay of treatment. Others indicated that they are unsure if they should be placing the order for the test or not – has another physician already ordered it? Would that test be helpful for the oncologist or is it out of scope for the intended path of treatment? There was significant uncertainty about where along the continuum of care the responsibility lay for ordering these tests.
d. The issue of send-outs not being reimbursed was raised as well. If this consortium could help to establish approved pathways for these tests to be ordered and reimbursed, it would be very helpful.
Interest Surveys
The Director of Oncology services volunteered to coordinate with people in identifying whether or not there is interest in joining the GTRQC. If people wish to participate, they should let her know by May 1 and she will forward the information to us with the champions identified.
Phone: 734-763-2616 ● ● www.GTRQC.org ● Fax: 734-936-2629