Introduction
Trinity Community hospital has come a long way to become one of the premier health facilities in the southwest of the United States. The hospital currently provides services such as internal medicine, pulmonary medicine, gastroenterology, urology, otolaryngology, general surgery, thoracic surgery, gynecology, and neurology. The hospital is committed to the provision of quality healthcare to the members of the community while enhancing the skills of the staff members. There are various services that need to be developed and have been captured in the Hospital’s five-year strategic plan. Members of the hospital board have agreed that there is a pressing need to position the hospital as the premier provider of orthopedic, cardiovascular, and cancer services.
The board strongly believes that this is the only way of ensuring the continued delivery of high-quality care to all patients in the community. This paper illustrates the feasibility of developing a cancer unit at Trinity community hospital. The paper will specifically evaluate the demand for new service line in the community; indicate the current international trends in healthcare and how they can be incorporated into the development of a cancer unit at the trinity community hospital; expound on the existing programs and service lines at Trinity community hospital and how they can be used to compliment a cancer unit; show an analysis of financial and operational data required for running an oncology unit; discuss the target and marketing referral services for physicians.
The demand for a cancer center by the community
Trinity community hospital is located in Jasper city, Hamilton County. The hospital receives patients from all over the county, though a huge fraction comes from the surrounding populated areas of the city. The city has a population of over 400,000 people, which grows at a rate of 4% annually. The growing population growth reflects the increased need for a comprehensive healthcare system. The community served by Trinity community hospital is continually experiencing increased cancer incidences and mortality mainly due to the rapidly changing lifestyles. Their area has several risk factors for cancer, particularly lung cancer, due to air pollution. The rapid growth of industries in the area means that there are increased cases of exposure to cancer-causing chemicals in the workplace (Bucci, Bevan, & Roach, 2005). There is an urgent need for a properly organized and ACOS accredited cancer center to offer quality cancer services to members of the community.
Trinity community hospital’s two main competitors, Tertiary Medical Center and the Regional hospital, both provide cancer services that are poorly organized with no ACOS accreditation. The only medical center that boasts of a comprehensive cancer center is located 60 miles away and does not pose significant competition to the community hospital. Furthermore, the center focuses on the provision of national and international cancer services and may not be adequately available for the local population.
Incorporation of international trends in cancer treatment at Trinity Community Hospital
Oncology services on the international scale are increasingly taking into account all the needs of a patient, rather than just focus on therapy for cure and palliation (Bucci, Bevan, & Roach, 2005). The treatment of cancer has offered a lot of challenges in the past, particularly in regard to the cytotoxic effects. This has prompted the development of different treatment strategies for both chemotherapy and radiological interventions. This section is interested in changing global trends in chemotherapy and radiation therapy. Oncology centers around the world are striving to provide quality care and compassion to every patient requiring cancer treatment. Any oncology center pursuing excellence should have a resident oncologist who is board-certified and with reasonable experience in cancer treatment. Best practice stipulates that the oncologist should work closely with other medical professionals such as medical physicists, radiation therapists, oncology nurses, dosimetrists, among other support staff (Meritage Healthcare Strategies, 2012). This team of medical professionals should be able to run the equipment needed to plan and administer radiation therapy besides offering compassion to cancer patients.
An ideal oncology unit should be composed of four main components: a linear accelerator, a CT simulator, a treatment planning system, and a high dose-rate (HDR) brachytherapy unit (Bucci, Bevan, & Roach, 2005). The four components effectively facilitate the planning and accomplishment of radiation therapy. The treatment planning system and the CT simulator are used for setting up and preparation of therapy for a particular patient. The HDR brachytherapy and the linear accelerator are used to deliver radiation therapy to the patient; the linear accelerator delivers external radiotherapy while the HDR brachytherapy is used for internal radiation therapy (Bucci, Bevan, & Roach, 2005). There are various models of CT simulators with different capabilities. For best practice, A CT simulator should allow for effective and accurate planning of a patient’s radiation therapy. A detailed definition of body structures should be achieved to properly direct the radiation and minimize harm to the neighboring health issues. This can be achieved using the Siemens Emotion Duo CT simulator (Bucci, Bevan, & Roach, 2005).
Newer versions of the linear accelerator such as the Siemens Oncor Linear accelerator have both the conventional beam therapy and the intensity-modulated radiation therapy (IMRT) capabilities (Bucci, Bevan, & Roach, 2005). The IMRT results in better treatment by providing a high radiation dose that causes minimal damage to the surrounding tissues. The IMRT is ideal for prostate, breast, head, and neck cancers. An ideal linear accelerator should also be able to offer daily verification of the treatment area through digital portal imaging or by use of films (Bucci, Bevan, & Roach, 2005). Most currently used HDR brachytherapy units are able to administer high doses of radiation to patients and therefore have significantly reduced the number of treatments. HDR brachytherapy is ideal for cancers affecting the cervix, esophagus, vagina, lung, rectum, and breast. Sites such as breast additionally require the use of a Mammosite for effective radiation distribution. The application of HDR brachytherapy and Mammosite in the treatment of breast cancer has made it possible for radiation therapy to be accomplished in five days. A period that is very short compared to up to six weeks when using external radiation beam (Bucci, Bevan, & Roach, 2005).
The current international practice in chemotherapy dispensation prioritizes orders for a pharmacy that are based on the anticipated patient appointment time at the cancer unit and not the time of arrival at the hospital (Meritage Healthcare Strategies, 2012). This new process has corrected a common problem that was often encountered when applying the first-come, first-served system. It takes into account the fact that some patients who come for chemotherapy services have to be cleared by a physician while others come straight to the cancer center and are ready for their regimen. This allows chemotherapy regimens to be prepared and prioritized in a manner that best reflects when patients are likely to be ready for their regimen (Meritage Healthcare Strategies, 2012).
The cancer center to be developed at the Trinity Community Hospital will incorporate all these practices in order to be at par with other centers providing quality cancer services.
Existing programs in the hospital that will compliment a cancer unit
The Trinity community hospital provides services such as internal medicine, pulmonary medicine, gastroenterology, urology, otolaryngology, general surgery, thoracic surgery, gynecology, and neurology. The hospital also provides all the basic services such as laboratory, pharmacy, radiology, physical therapy, and respiratory therapy. The radiology department provides X-ray, CT scan, MRI scan, ultrasound, and nuclear medicine services. A mobile PET scanner is also available though it’s poorly utilized. Most of these programs can complement an oncology unit in one way or another.
First, Trinity hospital has a state of the art laboratory that will be of great use in the investigation of tumor cells. Tissue samples obtained from the patient will be subjected to microscopic studies in the hospital laboratory. The laboratory will also be used to study the patient’s proteins, DNA, and RNA to determine the presence and extend of cancerous cells (Bucci, Bevan, & Roach, 2005). Therefore, the laboratory will be very important in studying biopsy specimens in the investigation of cancer. The radiology department will be used in studying and localizing cancer masses within the patient’s body. The use of cancer-specific radio imaging agents additionally will be able to determine how the patient is responding to treatment and detecting recurrence cases following surgery (Bucci, Bevan, & Roach, 2005). MRI can be used to localize biopsy sites when used in conjunction with tumor-specific antigens. This can be used effectively to accomplish the surgical removal of tumor cells. Therefore, the various departments involved in surgery will also compliment the cancer unit by offering an alternative way of treating cancer, though this will depend on individual case findings. The respiratory therapy department will assist in solving breathing difficulties in patients undergoing treatment for lung cancer.
The hospital pharmacy will also be of great importance to the running of the cancer unit. Many of the treatment agents and other solutions will be available at the pharmacy and will be used when needed. Additionally, the drugs to be used for various chemotherapy regimens will be stocked at the hospital pharmacy and will be dispensed to the cancer unit when required for patient administration.
Financial feasibility for a cancer unit at trinity hospital
The development of a cancer center at the Trinity community hospital underscores the hospital board’s desire to grow service volume, to operate efficiently, and generate more capital for investment. The development of a cancer center will cost an estimated $8,000,000. This includes the acquisition of a linear accelerator, a CT simulator, a treatment planning system, a high dose-rate (HDR) brachytherapy unit, and the renovation costs of vacant space in MOB1 (Bucci, Bevan, & Roach, 2005). In addition to the capital investment of 8 million dollars, there are needs for further enhancement of the service line in the next five years (Meritage Healthcare Strategies, 2012).
The operating costs include resources required to run the department both in terms of staff payments and maintenance of equipment. The future development of the oncology unit is consistent with the hospital’s mission of providing quality healthcare for all those in need of assistance. The demand for cancer treatment is increasing at a rate of 4% a year (Meritage Healthcare Strategies, 2012). Nearly half of all cancer patients are expected to receive radiation therapy at some point in their treatment, and therefore this area might produce real financial benefits if efficiently implemented. The oncology unit at the Trinity community hospital will foster excellence in Cancer prevention, registration, early detection, palliative care, and training (Meritage Healthcare Strategies, 2012). The center will have a resident board-certified radiation oncologist, radiation nurses, and other staff. For proper financial planning, the staffing level will be scaled to reflect activity levels.
The following five-year projections have been estimated considering the reimbursement trends, the growth of operations in volume and efficiency, payer mix, among other considerations.
Cancer—Five-Year Projection
- Gross charges per oncology discharge—$70,000
- Gross charges per radiation oncology treatment—$450
- Gross charges per chemo treatment—$600
- Collections—35%
- The ratio of cost to charges—30%
The cancer center hopes to attain the following growth and profitability in the course of the next five years
- 382 discharges
- Up to 9,100 radiation oncology treatments
- Up to 7000 chemotherapy treatments
- An operating margin of $ 1,337,000
Target and marketing referral services for a physician at the Trinity Hospital Cancer center
The cancer center at the Trinity community hospital will seek to position itself as a provider of quality and safe cancer services through adopting practices that will facilitate ACOS accreditation as a comprehensive community cancer center; accruing more than 8% of patients for clinical trials, and conducting ongoing community surveillance and screening for top four disease sites. The center seeks to achieve over 90% oncology nurse certification and staff retention in the course of the next five years. Inconsistent with our current ratings, the hospital hopes to maintain high levels of patient likelihood of recommending for cancer services.
As stated earlier, the cancer center will have a board-certified radiation oncologist who will be tasked with the responsibility of caring for all patients undergoing radiotherapy. He will work closely with other professionals such as the medical physicist, dosimetrist, and radiation therapists in the provision of quality healthcare to patients.
Therefore trinity community hospital cancer center will position itself as a center that provides quality and safe cancer services to attract physician referrals across the county. The hospital will take full advantage of the disorganized cancer services provided by its two main competitors.
References
Bucci, M., Bevan, A., & Roach, M. (2005). Advances in radiation therapy: Conventional to 3D, to IMRT, to 4D, and beyond. Cancer J Clin , 55(2):117-34.
Meritage Healthcare Strategies. (2012). Service Line Development. Web.