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    Ballad Health Cancer Care 2020 Annual Report January-December 2020


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    Table of contents Program distinction .................................................................................................................................................................................................... 1 Letter from our Vice President of Oncology Services ............................................................................................................................... 2 Cancer centers and practices ................................................................................................................................................................................ 3 Oncology services ...................................................................................................................................................................................................... 4 Multidisciplinary Cancer Case Conference ..................................................................................................................................................... 5 Colon cancer site study 2020 ............................................................................................................................................................................... 6 Patient assistance fund ............................................................................................................................................................................................ 9 Oncology research program ..................................................................................................................................................................................11 Breast imaging facilities ......................................................................................................................................................................................... 12 Breast cancer accountability report .................................................................................................................................................................13 Oncology navigator program ............................................................................................................................................................................... 17 Mission, Vision & Values Our mission Honor those we serve by delivering the best possible care Our vision To build a legacy of superior health by listening to and caring for those we serve Our values Creativity We seek to discover and promote innovative ideas and the unique talents of each team member to bring value to our community. Caring We listen with empathy and appreciation and respond with kindness and compassion. Honesty We own our actions and practice the highest ethical standards with transparency and fair behaviors. Respect We appreciate the strengths of our community and practice true collaboration and skilled communication in everything we do. Faith We nurture the mind, body and spirit of each individual to inspire hope and improve the health and well-being of our community. Quality We work as a team to bring best practices, advanced technology, and experiences to provide the highest-quality care. We devote ourselves to continuous improvement, service excellence, and a zero-harm environment. 2020 Cancer Care Annual Report | Ballad Health I


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    Program distinction Oncology Care Model (OCM): Ballad Health Recognized as a High Performer The Oncology Care Model (OCM) is a voluntary, five-year Medicare cost-savings initiative. Ballad Health physician practices that administer chemotherapy to fee-for-service (FFS) Medicare beneficiaries are eligible. The model focuses on the total cost of care for cancer patients undergoing chemotherapy during a six-month episode of treatment and ties payments to performance based on meeting certain quality metrics and practice transformation requirements. Ballad Health physician practices are continuously recognized as high performers. Population Health and Bundled Payment National Meeting Awards in OCM Ballad Health was recognized as a 2020 Award Winner! Positive Savings and Excellent Quality in OCM Performance Period 4 and 5 Most Improved in OCM Performance Period 5 Positive Savings and Excellent Most Improved in OCM Quality in OCM PP4 and PP5 PP5 versus PP4 Regional Cancer Center Regional Cancer Center Wellmont Medical Associates Program accreditation The Ballad Health Oncology program is accredited by both the American College of Surgeons, Commission on Cancer (CoC) & and American College of Radiology (ACR). 1 2020 Cancer Care Annual Report | Ballad Health


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    Letter from our Vice President of Oncology Services Cancer care is an extremely vital service that Ballad Health provides to patients across the Appalachian Highlands region, and I am honored to lead such a prestigious program. As part of my role as vice president of Ballad Health’s oncology services, I work with physicians and caregivers across the health system to ensure we deliver cancer care that meets the highest quality standards and achieves maximum value for our patients and their families. I joined Ballad Health in November 2019, and not long after my arrival, I quickly realized that our Tony Dotson cancer centers are filled with team members who genuinely care about their patients and are eager to help patients fight back against cancer. Seeing their compassion and dedication reassured me that I had joined a health system that puts patients above all else. In early 2020, I began working with Ballad Health’s oncology leadership team on an endeavor to accredit all of Ballad Health’s cancer centers under one program through the American College of Surgeons’ Commission on Cancer. Gaining this accreditation will foster multidisciplinary collaboration among caregivers, but most importantly, this effort will facilitate improvements to safety, quality and outcomes throughout our health system, ensuring our cancer patients receive the best possible care. Of course, just as we started this initiative, healthcare across the nation changed due to the coronavirus disease 2019 (COVID-19) pandemic. Not only did the pandemic delay our accreditation process, it completely upended the way healthcare is delivered across the nation. During the pandemic, while many elective healthcare services were completely halted or reduced, our cancer centers at Ballad Health remained fully operational. Cancer patients across the region still received the same quality care from our cancer center team members, who made sure the needs of our patients remained our top priority. Our team members’ dedication to selflessly serving our patients during 2020 confirmed the respect and admiration I have for them, and as I reflect back on this past year, it makes me extremely proud to work for Ballad Health and lead its cancer care program. Whether its during a pandemic or not, our patients will never be alone in their fight against cancer. Tony Dotson, FACHE Vice President of Oncology Services Ballad Health 2020 Cancer Care Annual Report | Ballad Health 2


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    Cancer centers and practices Service map rvice map LEBANON, VA NORTON, VA Buchanan Tazewell MARION, VA VA Dickenson Wise Wythe Russell Smyth Lee Scott Washington Grayson ABINGDON, VA Hancock Sullivan Hawkins Johnson BRISTOL, VA Washington Carter Hamblen BRISTOL, TN Greene Cocke Unicoi JOHNSON CITY, TN TN KINGSPORT, TN GREENEVILLE, TN Ballad Health Cancer Center Territory Map - Upd Ballad Health Cancer Center Territory Map - Updated January 2021 REGIONAL TERRITORIES Southeast Northwest Southwest Northeast 3 2020 Cancer Care Annual Report | Ballad Health


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    Oncology services Quick reference guide Tennessee Bristol Johnson City Kingsport Oncology Oncology Oncology Tamara Musgrave, MD Kanishka Chakraborty, MD Marcus DaSilva, MD Ryan Shao, MD Devapiran Jaishankar, MD Paul Kramer, MD Kelley Mayden, FNP Koyamangalath Krishnan, MD Jamal Maatouk, MD Kathy Sharp, FNP Sakshi Singal, MD Ibrahim Nakhoul, MD Kim Nichols, NP Elnora Spradling, MD Asheesh Shipstone, MD Jamie Carnell, NP Yonette Paul, MD Radiation Oncology Julia Davenport, FNP Whitney Maden, FNP John Fincher, MD Ruth Johnson, FNP Jessie Begley, NP Matthew Gestout, MD Kevin Blake, NP Radiation Oncology Shirley Davis, NP Greeneville Kyle Colvett, MD Alicia Deirth, NP Nathan Floyd, MD Sarah Falconer, PA Oncology Paige Goforth, PA Dharmen Patel, MD Mistie Hagaman, NP Anil Tumker, MD Tracy Romans, NP Miranda Thomas, NP Radiation Oncology Wendy Vogel, NP John Boys, MD Radiation Oncology Scott Coen, MD Rachael Carter, NP Virginia Abingdon Bristol Marion Oncology Oncology Oncology T. Mark Davis, MD Tamara Musgrave, MD Ahmad Hammad, MD Ahmad Hammad, MD Ryan Shao, MD Jessica Hill, NP Kenneth More, MD Kelley Mayden, FNP Ashley Jenkins, FNP Kathy Sharp, FNP Norton Whitney Fullen, NP Kim Nichols, NP Lydia Novruzov, PA Oncology Radiation Oncology Nicholas Cook, MD Radiation Oncology John Fincher, MD Harish Madala, MD Bernie Tisdale, MD Matthew Gestout, MD April Wallace, NP Lebanon Radiation Oncology Scott Coen, MD Oncology Rachael Carter, NP Kenneth More, MD Cathy Hopkins, PA 2020 Cancer Care Annual Report | Ballad Health 4


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    Multidisciplinary Cancer Case Conference Ballad Health Cancer Care (BHCC) is committed to based on National Comprehensive Cancer Network delivering high quality, comprehensive cancer care. (NCCN) cancer treatment guidelines. The team of The primary method used to accomplish this is through physicians and ancillary caregivers, which includes multi-disciplinary treatment conferences. Each week research, dietitians, genetics, rehab, nurse navigators all primary specialties comprising cancer treatment and social workers, openly discuss the needs and best (Medical Oncologists, Radiation Oncologists, Surgeons, options for patients. The plan of care is deployed with Pathologists and Radiologists) come together in input from all stakeholders. The table below reflects a conference format to discuss the best and most all the cancer treatment conferences that take place at appropriate treatment options tailored to each patient Ballad Health facilities. Physician Facility Conference type Frequency Location Time champion Every other Breast Azalea Room 7:30 a.m. Morgan Tuesday Bristol Regional Medical Center Lung Every Friday Azalea Room Noon Messerschmidt Cancer Every Friday Azalea Room 12:30 p.m. Gestaut Johnston Memorial Johnston Second Tuesday Hospital Cancer Memorial Cancer Noon More of each month Care Conference Hospital Room Breast Every Tuesday Heritage Room Noon Ehrenfried Every Lung Heritage Room Noon Greenfield Holston Valley Wednesday Medical Center GI Every Tuesday Heritage Room 12:30 p.m. Ehrenfried ENT Every Tuesday Heritage Room 12:30 p.m. Osterhaus Lonesome Pine Hospital VC with Holston Remote into (Southwest Valley Medical Holston Valley Above Virginia Cancer Center Medical Center Center) Second and Cancer fourth Monday Tennessee Room Noon Colvett of the month Radiation Oncology Johnson City First Friday of Conference Room Neuro Noon Schweitzer Medical Center the month at Johnson City Medical Center Third Melanoma Wednesday of TBD 7 a.m. Lawson every month Greeneville Greeneville Community Community Cancer Monthly Noon Boys Hospital East Hospital Conference Room 5 2020 Cancer Care Annual Report | Ballad Health


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    Colon cancer site study 2020 Harish Madala, MD; Tamara Musgrave, MD; Kelley Mayden, NP Organizations committed to providing high-quality, evidence-based, cost-effect care (value-based care) must survey institutional practices and compare institutional findings to nationally-adopted benchmarks. The purpose of this site study is to compare and benchmark cancer care practices throughout the Ballad Health network as a means for promoting best Harish Madala, MD Tamara Musgrave, MD Kelley Mayden, NP practices and identifying opportunities for growth, improvement and education at the organizational, Excluding skin cancer, colon cancer is the third community and population levels. The aims of this study most frequently diagnosed cancer and the second include the following and pertain to patients with colon leading cause of cancer mortality in the United States cancer treated by Ballad Health Cancer Care specialists: (American Cancer Society [ACS], 2020). The death • Review of adherence to the NCCN guidelines in rate from colon cancer has been declining for several treating colon cancer decades (Siegel, et al., 2020). Reasons for the decline • Examine the rate of appropriate surgical lymph node include improved screening efforts, cancer detection in harvest (12 nodes) earlier stages and precision medicine. More than half of • Document the rate of synoptic reporting on colon all deaths are attributable to modifiable risk factors such cancer pathology reports as excess alcohol use, physical inactivity, obesity and • Identify the most common risk factors for colon smoking. Persons with type 2 diabetes are at increased cancer across the network risk for colon cancer. A third of patients diagnosed • Determine the frequency of MMR testing among colon with colon cancer have a family history of the disease, cancer patients highlighting the importance of familial identification • Correlate the percentage of appropriate genetic and genetic counseling (ACS, 2020). Cancer stage referrals to the number of secure referrals at diagnosis is predictive of survival, with five-year • Review the percentage of palliative care referrals for survival rates declining as cancer progresses from local patients with stage IV colon cancer to regional and distance spread. Patients diagnosed • Review the percentage of advanced directives for with metastatic colon cancer have a five-year survival patients with stage IV colon cancer rate of 14.2% (Weinberg, et al., 2020). Treatment for • Identify factors contributing to late presentation in metastatic patients is palliative and incorporates quality stage III and IV colon cancer of life, advanced care planning and appropriate pain management. Inclusion criteria • Patients age ≥ 18 years with a diagnosis of colon Management approaches for colon cancer include cancer surgery and systemic therapy. Surgical resection with • Patient received treatment at Ballad Health curative intent is the standard of care for non-metastatic Cancer Care colon cancer. Improved surgical lymph node harvest • Patients with stage III and IV colon cancer is associated with a survival benefit, 12 lymph nodes being the current harvest standard (Commission on Cancer [CoC], 2019). The American College of Surgeons Exclusion criteria • Patients age < 18 years (ACS) CoC supports this standard as well as synoptic • Treatment was not received at a Ballad Health facility reporting on pathology reports. Systemic therapy has • Patients diagnosed with rectal cancer been refined and incorporates tumor sidedness and individual molecular blueprints. Guidelines from the National Comprehensive Cancer Network (NCCN) Methods (2020) incorporate both in recommending the Patients diagnosed with colon cancer during 2016 and national evidence-based guidelines for therapy. An 2017 across the Ballad Health network were identified important part of the colon cancer molecular profile using the cancer registry. Charts were reviewed is the identification for mismatch repair (MMR) by through the use of the EPIC electronic health record immunohistochemistry. This is an expected pathology (EHR). Patients were categorized according to the standard and drives therapy decisions and genetic stage, age and location. Synoptic reporting, lymph referrals. node harvest and the presence or absence of MMR 2020 Cancer Care Annual Report | Ballad Health 6


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    Colon cancer site study 2020 immunohistochemical evaluation were determined by a indicated but not conducted in 23/114 (20.18%) of cases. review of pathology and operative reports. The media For patients with stage IV disease, 24/51 (47.06%) section of the EHR was also reviewed for MMR testing had advanced directives completed or on file, and results reported separately from the initial pathology. 18/51 (35.29%) of patients were referred to palliative Risk factors (alcohol use, inflammatory bowel disease, care services. The most common factor contributing diabetes, obesity, smoking) and factors contributing to late cancer presentation was delayed colonoscopy to a late presentation were isolated from initial consult screenings (absence of baseline colonoscopy or delayed notes, patient history and physicals, outside history follow-up colonoscopy in those with known risk factors) and physicals, and the history section of the EHR. occurring in 33/114 (28.95%) of cases. Referrals for genetic counseling and palliative care were determined by examining the notes, referral, Colon cancer incidence media and advanced directives sections of the EHR. National Cancer Treatment adherence to NCCN guidelines was based Age group Ballad Health Database on a comparison of each patient’s therapy to the NCCN guidelines for 2016 and 2017. Therapy plans were 40-49 12.28% 7.37% reviewed from provider notes, treatment and therapy 50-59 18.42% 18.23% plans, and the synopsis sections of the EHR. 60-69 31.58% 25.33% Results A retrospective chart review was conducted on a The average age at diagnosis was 64 years. As cohort (n=114) of patients selected from across the compared to averages available from the National Ballad Health network. All patients in the cohort were Cancer Data Base through the ACS, Ballad Health treated in accordance with NCCN guidelines. Diagnostic had an above average colon cancer incidence in the biopsies (n=18) of oligometastatic areas, such as the following age groups: 40-49 years (12.28% vs. 7.37%); liver, that would not yield lymph nodes were excluded in 50-59 years (18.42% vs. 18.23%); and 60-69 years the assessment of adequate lymph node harvest. Of the (31.58% vs. 25.33%). The unadjusted death rate from remaining eligible charts, 18/96 (18.75%) documented stage III colon cancer was 14/63 (22.2%) and 36/51 inadequate lymph node harvest at the time of surgery. (70.58%) from stage IV colon cancer. Synoptic reporting was identified on 113/114 (99%) of charts. MMR testing was reported in 77/114 (67.5%) of patients. Conclusion Within the Ballad Health network, the treatment of colon cancer aligns with NCCN guidelines in 100% of cases. For total Stage III and IV colon cases reviewed Surgical lymph node harvest is appropriate 81.25% of the time, this is just slightly under the 85% standard NCCN guidelines used 100% outlined by the CoC. Pathological synoptic reporting Documented inadequate occurs in 99% of cases, this exceeds the CoC standard lymph node harvest at 19% time of surgery of 95%, as well as meets the standard of the College of American Pathologists. The NCCN recommends Synoptic reporting 99% universal MMR testing in all newly-diagnosed colon cancer patients in CLIA-approved laboratories. The MMR testing reported 68% presence of testing in 67.5% of patients falls below this established standard. All Ballad Health laboratories are Genetic referrals not conducted 20% CLIA-certified. Advanced directives on 47% Diabetes, obesity and smoking are the leading risk Stage IV factors for the development of colon cancer among Referred to palliative care 35% Ballad healthcare recipients. A predominating reason for late-stage III and IV colon cancer presentations is the 0% 50% 100% 150% absence of age-appropriate screening colonoscopies and delayed colonoscopies in those with previously Risk factors common to the cohort were present as identified risk factors. Diagnosis among those ages follows: alcohol use 11/114 (9.6%); IBD 2/114 (1.75%); 40-69 years exceeds the national averages compared diabetes 26/114 (22.8%); obesity 34/114 (29.8%); to all hospitals reporting to the National Cancer Data and smoking 60/114 (52.6%). Genetic referrals were 7 2020 Cancer Care Annual Report | Ballad Health


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    Colon cancer site study 2020 Base. The rate of genetic referrals in appropriate cases • Interprofessional collaboration with population health does not meet the NCCN goal of referral for all patients to develop interventions that address diabetes, identified at risk for genetic susceptibility to colon obesity and smoking throughout the Ballad Health cancer. The low rates of advanced directive completion network and referrals for stage IV cancer to palliative care are • Interprofessional collaboration with population health lower than the recommended referral rate of 100% by to increase the rate of age-appropriate screening for the NCCN for patients with metastatic solid tumors. colon cancer throughout the Ballad Health network The unadjusted death rates represent viable targets for improvement. References • American Cancer Society. Colorectal Cancer Facts & Benchmark comparison for late stage colon Figures 2020-2022. Atlanta: American Cancer Society; National 2020. Measure Ballad Health Standard • Commission on Cancer. (2020). Optimal resources for Surgical lymph cancer care: 2020 standards. https://www.facs.org/ 81.25% 85.00% Quality-Programs/Cancer/CoC/standards node harvesting • National Comprehensive Cancer Network. Synoptic 99.00% 95.00% Colon cancer (v4.2020). https://www.nccn.org/ reporting professionals/physician-gls/pdf/colon.pdf MMR testing 67.50% 100.00% • Siegel, R., Miller, K., D., Sauer, A. G., Fedewa, S. A., Butterly, L. F., Anderson, J. C., Cercek, Genetic referral 67.50% 100.00% • A., Smith, R. A., & Jemal, A. (2020). Colorectal cancer Advance statistics, 2020. CA: A Cancer Journal for Clinicians, 47.00% 100.00% 70(3), 145-164. https://doi.org/10.3322/caac.2160 directives • Weinberg, B. A., Armstrong, A. S., & Malley, R. (2020). Palliative 35.00% 100.00% Molecular profiling in metastatic colorectal cancer. referral Oncology, 34(9). https://www.cancernetwork.com/ view/molecular-profiling-in-metastatic-colorectal Future implications cancer • Interprofessional education of network surgeons to • https://www.facs.org/Quality-Programs/Cancer/CoC/ assure adequate surgical lymph node yield standards • Interprofessional education of pathologists to assure universal MMR testing on biopsy samples • Interprofessional education of primary care providers about the importance of referral for age-appropriate screening colonoscopies • Interprofessional education of primary care providers about appropriate query of risks for familial colon cancer and avenues for timely genetic referral • Interprofessional collaboration with the genetic counseling service line to ensure newly diagnosed colon cancer patients are screened and appropriately tested for familial syndromes • Interprofessional collaboration with the palliative care service line to increase the rate of referrals in stage IV colon cancer 2020 Cancer Care Annual Report | Ballad Health 8


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    Patient assistance fund How was it spent? Imagine undergoing cancer treatment; you’re sick, scared and fighting for your life. Now imagine, in the middle of treatment, the financial toll has become so heavy you can no longer afford gas, electricity or car payments. For too many people in our region, that’s a frightening reality — which is why the cancer patient assistance fund, overseen by Ballad Health Foundation, is so important. Known as the Circle of Hope fund, it provides assistance for things like gas vouchers, taxi fare, non-covered medications, nutritional expenses, personal care items and electric bills. This fund exists to make things a little easier for patients in their time of need. Patient assistance fund spend detail 2015-2020 CY15 CY16 CY17 CY18 CY19 CY20 Mortgage/rent 6% 6% 9% 13% 11% 10% Medications 18% 20% 18% 18% 15% 19% Utilities 36% 43% 38% 41% 43% 23% Gas cards 16% 21% 4% 5% 10% 30% Food City cards 20% 9% 30% 17% 16% 9% Other 4% 2% 2% 6% 6% 7% Total 100% 100% 100% 100% 100% 100% Average number of patients Assistance by location helped each month. 150 Average amount of money given out in total each month. $15,600 47% Northwest Market Average amount of money 42% Northeast Market each patient receives. 11% Southwest Market $102 9 2020 Cancer Care Annual Report | Ballad Health


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    Patient assistance fund How was it spent? Annual spend trend $200,000 $185,456 $159,684 $150,000 $123,239 $103,524 $100,000 $81,936 $69,924 $51,660 $42,000 $50,000 $33,660 0 CY12 CY13 CY14 CY15 CY16 CY17 CY18 CY19 CY20 Patient assistance funds (Spend trend per month) $50,000 $40,000 $30,000 $20,000 $10,000 $0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2019 2020 2020 Cancer Care Annual Report | Ballad Health 10


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    Oncology research program The Ballad Health Oncology While many of our clinical trials involve new treatments Research program spans many and therapy, we also participate in research that offices in Kingsport, Bristol, Norton addresses cancer prevention and control, supportive and Johnson City involving our care, symptom management and health disparities. oncologists/hematologists, radiation With support from our corporate research department, oncologists and surgical oncologists. we have a team of research staff that includes Several of our physicians serve as Jackie Pierson, Janet Mullins, Ruth Couch, RN, Anna Justin Reynolds principal investigators across our Yakubenko, RN, and Justin Reynolds, BS, CCRP. portfolio of research trials. Ballad Health partners with pharmaceutical While COVID-19 has slowed research enrollments in companies, academic institutions and the National 2020, we look forward to growing oncology clinical Cancer Institute to bring cutting-edge research to trials across our network in the near future. the Appalachian Highlands so that our patients can participate in clinical trials in their own communities. Year of enrollment: CY19 Year of enrollment: CY20 (through October) Number of subjects Number of subjects Type of research study Type of research study consented and enrolled consented and enrolled Clinical trials 19 Clinical trials 8 Diagnostic trials 0 Diagnostic trials 0 Genetic studies 3 Genetic studies 1 Prevention and control Prevention and control 0 0 research studies research studies Quality of life and Quality of life and 44 11 economics of care studies economics of care studies Bio-respiratory/bio-bank Bio-respiratory/bio-bank 389 186 studies studies Patient registry studies 4 Patient registry studies 0 Other specified 0 Other specified 0 Total 459 Total 206 Percentage enrolled 11% Percentage enrolled 6% INCP standard = 6% 11 2020 Cancer Care Annual Report | Ballad Health


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    Breast imaging facilities Ballad Health expanded the fight against breast cancer in 2020 throughout the Appalachian Highlands. Locations of breast imaging facilities are depicted in the service area map below. Ballad Health was able to perform 409 mobile breast cancer screenings compared to 341 screenings in 2019. Since the EPIC go live, our health system has completed 13,187 mammograms with 103 true positive exams. The EPIC electronic medical record allows us to evaluate the outcomes of our whole system. Buchanan VA Wise Dickenson Tazewell Norton Russell Lebanon Wythe Marion Smyth Abingdon Lee Scott Washington Grayson Kingsport Bristol Hancock Hawkins Sullivan Johnson Rogersville Elizabethton Johnson City Washington Carter Hamblen Greeneville Greene Unicoi Cocke TN 13,187 breast cancer screenings 103 true positive exams 2020 Cancer Care Annual Report | Ballad Health 12


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    Breast cancer accountability report Interpreting the report: The estimated performance rates shown below provide your cancer program with an estimate of the proportion of patients concordant with measure criteria by diagnosis year. If appropriate, the Commission on Cancer (COC) standard and benchmark compliance rate is provided. This application provides our cancer programs the opportunity to examine data to determine if performance rates are representative of the care provided at the institution and to review and modify case information using the review function for the measure of interest. Bristol Regional Medical Center Ballad Health performance rates (%) Primary 2017 Measure Measure description COC goal 2015 2016 site Estimated Performance Performance performance rate rate rate Radiation therapy is administered within one 96.30% 92.68% 92.86% PR/EPR year (365 days) of diagnosis [89.17% – [84.71% – [85.07% – Breast BCSRT 95% CI for women under age 70 100.00%] 100.00%] 100.00%] Benchmark receiving breast conserving 90% 90% 90% surgery for breast cancer Tamoxifen or third generation aromatase inhibitor is recommended 87.93% 94.92% 87.50% or administered within one PR/EPR [79.55% – [89.31% – [78.84% – HT year (365 days) of diagnosis 95% CI 96.31%] 100.00%] 96.16%] for women with AJCC Benchmark 90% 90% 90% T1cN0M0, or stage IB - III hormone receptor-positive breast cancer Radiation therapy is recommended or administered following any 85.71% 100.00% 100.00% PR/EPR mastectomy within one year [59.79% – [100.00% – [100.00% – MASTRT 95% CI (365 days) of diagnosis of 100.00%] 100.00%] 100.00%] Benchmark breast cancer for women 90% 90% 90% with > 4 positive regional lymph nodes Image or palpation-guided 90.20% 84.76% needle biopsy to the PR/EPR 84.31% [84.43% – [77.89% – nBx primary site is performed to 95% CI [77.26% – 91.37%] 95.97%] 91.64%] establish diagnosis of breast Benchmark 80% 80% 80% cancer 13 2020 Cancer Care Annual Report | Ballad Health


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    Breast cancer accountability report Greeneville Community Hospital East Ballad Health performance rates (%) Primary 2017 Measure Measure description COC goal 2015 2016 site Estimated Performance Performance performance rate rate rate Radiation therapy is administered within one 90.91% 100.00% 95.00% PR/EPR year (365 days) of diagnosis [73.92% – [100.00% – [85.45% – Breast BCSRT 95% CI for women under age 70 100.00%] 100.00%] 100.00%] Benchmark receiving breast conserving 90% 90% 90% surgery for breast cancer Tamoxifen or third generation aromatase inhibitor is recommended 100.00% 88.89% 76.19% or administered within one PR/EPR [100.00% – [74.37% – [57.97% – HT year (365 days) of diagnosis 95% CI 100.00%] 100.00%] 94.41%] for women with AJCC Benchmark 90% 90% 90% T1cN0M0, or stage IB - III hormone receptor-positive breast cancer Radiation therapy is recommended or administered following any 100.00% 100.00% PR/EPR mastectomy within one year [100.00% – [100.00% – Data not MASTRT 95% CI (365 days) of diagnosis of 100.00%] 100.00%] available Benchmark breast cancer for women 90% 90% with > 4 positive regional lymph nodes Image or palpation-guided 100.00% 100.00% 93.75% needle biopsy to the PR/EPR [100.00% – [100.00% – [85.36% – nBx primary site is performed to 95% CI 100.00%] 100.00%] 100.00%] establish diagnosis of breast Benchmark 80% 80% 80% cancer 2020 Cancer Care Annual Report | Ballad Health 14


  • Page 17

    Breast cancer accountability report Holston Valley Medical Center Ballad Health performance rates (%) Primary 2017 Measure Measure description COC goal 2015 2016 site Estimated Performance Performance performance rate rate rate Radiation therapy is administered within one 87.50% 87.23% PR/EPR 91.30% year (365 days) of diagnosis [76.04% – [77.69% – Breast BCSRT 95% CI [83.16% – 99.45%] for women under age 70 98.96%] 96.77%] Benchmark 90% receiving breast conserving 90% 90% surgery for breast cancer Tamoxifen or third generation aromatase inhibitor is recommended 91.25% 94.87% 92.63% or administered within one PR/EPR [85.06% – [89.98% – [87.38% – HT year (365 days) of diagnosis 95% CI 97.44%] 99.77%] 97.89%] for women with AJCC Benchmark 90% 90% 90% T1cN0M0, or stage IB - III hormone receptor-positive breast cancer Radiation therapy is recommended or administered following any 91.67% 83.33% 75.00% PR/EPR mastectomy within one year [76.03% – [53.51% – [44.99% – MASTRT 95% CI (365 days) of diagnosis of 100.00%] 100.00%] 100.00%] Benchmark breast cancer for women 90% 90% 90% with > 4 positive regional lymph nodes Image or palpation-guided 96.93% 91.74% 86.27% needle biopsy to the PR/EPR [94.29% – [86.83% – [80.82% – nBx primary site is performed to 95% CI 99.58%] 96.64%] 91.73%] establish diagnosis of breast Benchmark 80% 80% 80% cancer 15 2020 Cancer Care Annual Report | Ballad Health


  • Page 18

    Breast cancer accountability report Johnson City Medical Center Ballad Health performance rates (%) Primary 2017 Measure Measure description COC goal 2015 2016 site Estimated Performance Performance performance rate rate rate Radiation therapy is administered within one 100.00% 83.72% 94.92% PR/EPR year (365 days) of diagnosis [100.00% – [72.69% – [89.31% – Breast BCSRT 95% CI for women under age 70 100.00%] 94.76%] 100.00%] Benchmark receiving breast conserving 90% 90% 90% surgery for breast cancer Tamoxifen or third generation aromatase inhibitor is recommended 94.20% 96.30% 93.33% or administered within one PR/EPR [88.69% – [91.26% – [87.69% – HT year (365 days) of diagnosis 95% CI 99.72%] 100.00%] 98.98%] for women with AJCC Benchmark 90% 90% 90% T1cN0M0, or stage IB - III hormone receptor-positive breast cancer Radiation therapy is recommended or administered following any 100.00% 75.00% 100.00% PR/EPR mastectomy within one year [100.00% – [32.56% – [100.00% – MASTRT 95% CI (365 days) of diagnosis of 100.00%] 100.00%] 100.00%] Benchmark breast cancer for women 90% 90% 90% with > 4 positive regional lymph nodes Image or palpation-guided 98.35% 98.13% 97.39% needle biopsy to the PR/EPR [96.08% – [95.56% – [94.98% – nBx primary site is performed 95% CI 100.00%] 100.00%] 100.00%] to establish diagnosis of Benchmark 80% 80% 80% breast cancer 2020 Cancer Care Annual Report | Ballad Health 16


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    Oncology navigator program Our oncology navigators serve as a point of contact or surgery in one state and their treatment from for cancer patients and their families throughout their their oncologist in another state. The navigators do cancer journey, from the time of diagnosis to end of life an excellent job communicating to each other so and survivorship. the patient receives seamless care with effective communication to all involved, regardless of where they The navigation program is divided into three units: are in the system. community navigators/social workers, lung nodule navigators/coordinators and nurse navigators. All Like everyone else, we were impacted by COVID-19. three units work hand-in-hand to ensure that patients As care moved to telehealth and support groups went flow through the complex healthcare system. The virtual, we had to adapt and continue to meet the needs oncology navigators provide this service by answering of patients in a unique manner. The navigators got very questions about what to expect throughout care, creative from leaving wigs on a bench in front of the assisting with coordination of appointments and hospital to directing patients to support groups through treatments, and helping provide education and Zoom. In addition, the navigators increased their calls emotional support. In addition, the navigators to patients for follow-up and to answer questions from help coordinate resources for treatment planning, family members who normally would’ve been able to nutritional counseling, financial support, transportation, attend an appointment, but couldn’t due to COVID-19 community event and support groups. visitor restrictions. One thing we are especially proud of is the way our Overall, we are extremely proud of the navigation navigators meet the needs of the patients, from follow- program at Ballad Health. The team has a passion to through of lung nodules for early detection to financial serve patients and their families with excellent care. assistance for transportation, utilities and mortgage. Many team members have their own personal story When patients come back and tell us how much it of how cancer has affected them or someone they meant that we helped them with their electric bill or love. This often drives them to want to give their very took the time to meet with them after they received best and go above and beyond for patients and their their diagnosis, that’s our “why,” and what makes us loved ones. proud to do what we do. The navigators are a shining example of how to coordinate care for patients across state lines and counties. Oftentimes we will have a patient receiving chemotherapy in one county and radiation in another, 17 2020 Cancer Care Annual Report | Ballad Health


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