Smilow Cancer Hospital Town Hall | January 24, 2024

Transcript

• 00:00Welcome to this Milo
• 00:02Cancer Hospital Town Hall.
• 00:04We're very thankful and appreciative
• 00:06of everyone taking time to join
• 00:08us this evening and hopefully
• 00:09going to provide you with some
• 00:11really exciting news and updates
• 00:15just to go over the agenda quickly.
• 00:16Doctor Billingsley and myself will
• 00:19do some quick announcements and
• 00:21recognition and then we are going to
• 00:25hear from Doctor Henry Park regarding
• 00:28Reflexion radiotherapy exclusively
• 00:30in the Northeast at Smilo. Dr.
• 00:33Vita Guerra will talk about genetic testing,
• 00:35referrals and ordering.
• 00:36And then Mandy Merle is going to
• 00:38speak to us on early release of
• 00:41medication orders followed by Maddie
• 00:43Callahan who will be talking about
• 00:45improving patients quality of life
• 00:47through our excellent supportive
• 00:48care program that she's leading.
• 00:50And then we do have question and
• 00:53answer session that will be moderated.
• 00:55There's a chat that you can put and
• 00:58some were sent in ahead of time.
• 00:59So we'll be hopefully giving time
• 01:02for questions and responding to that
• 01:04chat throughout the presentation.
• 01:08I'm going to turn it over
• 01:09to Doctor Billingsley.
• 01:10Yeah, thank you, Tracy.
• 01:12And again, I also want to extend a
• 01:15note of welcome and gratitude for
• 01:17people taking the time to be here
• 01:19despite the winter dreary weather.
• 01:23We have lots of exciting development
• 01:26and growth and SMILO and the Yale
• 01:29Cancer Center and the cancer enterprise
• 01:32across the organization and it's just
• 01:35wonderful to bring these updates.
• 01:37I first wanted to take some time to
• 01:39talk about growth and development
• 01:41in the Center for Thoracic Cancers.
• 01:44As this community knows,
• 01:46this has been one of our true signature
• 01:50programs and has been a program which
• 01:53has not only provided outstanding
• 01:56clinical care across the organization,
• 01:58but has been an engine of clinical
• 02:02trials and research that have really
• 02:04delivered life changing therapy
• 02:06to lung cancer patients across
• 02:08the country and around the world.
• 02:10And like all great organizations there,
• 02:13we have been going through an exciting
• 02:16leadership change in development.
• 02:19And in recent years,
• 02:20this program has been under the really
• 02:23wonderful stewardship of Doctor
• 02:25Roy Herbst and Doctor Dan Boffa,
• 02:28medical oncology and surgical
• 02:31oncology leaders.
• 02:32And I would also be remiss if I did
• 02:35not mention the strong history of
• 02:37this program that developed under the
• 02:40leadership not only of Roy and Dan,
• 02:43but of Frank Detterbeck,
• 02:45Doctor Lynn Tenui and of course
• 02:48the incomparable Roy Decker.
• 02:50So just a moment to to reflect
• 02:53on their contributions and be
• 02:55grateful for them as well.
• 02:57But the exciting new chapter
• 03:00in thoracic oncology,
• 03:01we do have new leadership coming
• 03:03forward and doctor Sarah Goldberg,
• 03:06Medical Oncology Associate Professor
• 03:08has stepped forward and she will be Co
• 03:12leading with doctor Justin Blasberg,
• 03:14thoracic surgery,
• 03:15thoracic surgical oncologist,
• 03:18associate professor in the
• 03:19Department of Surgery.
• 03:20Both of these are remarkable clinicians,
• 03:23researchers and leaders in our
• 03:27organization and it's exciting to see
• 03:29them both step forward to take a more
• 03:32prominent role in this terrific program.
• 03:34So Sarah and Justin,
• 03:36welcome and thank you.
• 03:38We know the program's going to
• 03:41continue to thrive under your guidance.
• 03:44Next please.
• 03:47As a gastrointestinal surgical oncologist,
• 03:50I'm particularly excited to share
• 03:54this next piece of news and
• 03:56development is the audience knows
• 03:59the Center for Advanced Endoscopy
• 04:02has been for many years a pillar
• 04:06of our GI oncology program.
• 04:09The services that this group of
• 04:12gastroenterologists offer are truly
• 04:14remarkable ranging from endoscopy to
• 04:17ERCP to stent placement to endoscopic
• 04:20ultrasound to very complicated both
• 04:23therapeutic and palliative interventions
• 04:26for patients with GI cancer.
• 04:29It's a unique set of services really in
• 04:32the state and they offer some of the
• 04:35most innovative procedures in the Northeast.
• 04:38Doctor Jamadar has been really at the
• 04:41forefront of this for many years,
• 04:43has been a steward of the program
• 04:47and a trailblazer in this area.
• 04:49He will continue to see patients
• 04:52and be a very active clinician
• 04:55and advisor in the program,
• 04:57but the torch of leadership will
• 05:00be passing to Doctor Thiru Muniraj.
• 05:02Many of you know Thiru Thiru is an
• 05:06outstanding individual.
• 05:06He's a wonderful clinician.
• 05:08He's beloved by both his
• 05:10colleagues and his patients.
• 05:12And I think it's really well
• 05:15positioned to lead the center
• 05:17in the future months and years.
• 05:19So very excited to share this development.
• 05:22Next I'll kick it back to you, Tracy.
• 05:27Yeah, and we are also excited
• 05:30to announce that Angela Carrera
• 05:32will be joining us as the interim
• 05:34Manager for oncology social work
• 05:36across the Smilo enterprise.
• 05:38And Angela comes with a lot of
• 05:41knowledge and commitment to our
• 05:43patients over the last decade in SMILO,
• 05:45She has worked in the SMILO
• 05:48Survivorship Clinic,
• 05:49the Breast Center and the Psycho
• 05:51Oncology program and brings a lot
• 05:54of experience in leadership to work
• 05:56with our teams as we move and develop
• 05:58social work across the continuum.
• 06:00So we look forward to Angela coming
• 06:02on board and she will be coming
• 06:05to a town hall soon to share sort
• 06:07of her vision for social work
• 06:09in the next few months.
• 06:14We wanted to give
• 06:15you an update on you know sort of the
• 06:18hospital surge that's currently happening.
• 06:21I think most people are aware that we've
• 06:24been in a sort of a surge operations for
• 06:28the last several weeks and it it seems to
• 06:31progress each day to a worse situation.
• 06:33This is just an example from this morning
• 06:36of where we stood when we started the
• 06:39morning with our total census and you
• 06:41know capacity at both organizations.
• 06:43I think what we really want to highlight
• 06:46here is that there were 74 patients
• 06:48boarding in the Ed this morning.
• 06:51Those are patients waiting that are
• 06:53already have admission orders but no
• 06:55bed to be assigned and nineteen of
• 06:57them had been there over 24 hours.
• 06:59So as everyone understands,
• 07:01that's a really unsafe situation and
• 07:04we've had some serious safety events
• 07:06in the Ed due to overcrowding and if
• 07:09anyone's walked down there during this
• 07:11time it's it's it's like a war zone,
• 07:14it's very concerning.
• 07:15So several things are being put into
• 07:19place to try and alleviate some of
• 07:22the burden in the Ed As of today.
• 07:25Hallway beds have been used in the
• 07:28medicine service line for quite
• 07:31a while during these surges,
• 07:32but it has opened up and now
• 07:35will include three of our units,
• 07:38NP 1214 and 15 in Smilo.
• 07:40But it's also opening up to all,
• 07:42many of the other surgical units
• 07:45across all of the towers.
• 07:47They are seeing a significant number
• 07:49of surgery patients boarding in
• 07:51the Ed which is a new phenomenon.
• 07:53So these will be patient with,
• 07:55these will be our own patients and
• 07:58there are exclusion criteria as as far
• 08:01as who is appropriate to be in the
• 08:03in those hallway beds and each unit
• 08:05will have one designated hallway bed.
• 08:08They are encouraging.
• 08:09We are encouraging people to pursue
• 08:12outpatient evaluations for non urgent
• 08:14issues and there was discussion of
• 08:17sort of social media and campaigns
• 08:19again around using urgent care
• 08:21centers instead of the Ed.
• 08:23We also have the closer to home
• 08:26lounges that we can send patients
• 08:28to that are staffed with APCA.
• 08:31Those are patients who are ready to
• 08:33go home but you know don't have a
• 08:35ride and need to wait for a while.
• 08:37And then as a reminder,
• 08:39we also have the home hospital
• 08:41inpatients can get transferred to
• 08:43home hospital if they're not quite
• 08:45ready to go home alone and and sort
• 08:48of ready to launch from the hospital
• 08:50and there is a a whole team that works
• 08:53on facilitating that if we identify patients.
• 08:56So we're we're asking everyone to
• 08:58sort of get on board in this endeavor
• 09:00to try and really ensure that we can
• 09:03move patients through our system in
• 09:05order to get new patients is it's
• 09:07a it's a good thing that we have
• 09:09volume but we want to ensure safety.
• 09:11And I think Kevin also wanted to
• 09:12add a few words.
• 09:14Thank. Thank you, Tracy.
• 09:17You know, I think like always
• 09:19we care for cancer patients,
• 09:21but we are also part of a larger
• 09:24healthcare system and we play a
• 09:26pivotal role in function within
• 09:28that system to ensure capacity not
• 09:30only for care of cancer patients,
• 09:33but the entire spectrum of patients
• 09:36from Connecticut and beyond who require
• 09:39hospitalization for their illness.
• 09:41So it is incumbent upon us to
• 09:45participate as great citizens
• 09:47and that as we always do,
• 09:49as we did in the pandemic and
• 09:51as we continue to do.
• 09:53And it is hard to overstate the
• 09:56impact of the current capacity crisis.
• 09:59I did my first case yesterday
• 10:01and my second operative case.
• 10:03The patient was in the pre op
• 10:05holding area and she was on hold
• 10:07for about four hours till we can
• 10:09ensure that there's a bed for her
• 10:11to go into after the procedure.
• 10:13So we are at a point where we are
• 10:16struggling to deliver care to patients
• 10:18because we don't have the capacity.
• 10:21I just need to take a minute and under
• 10:23score the role that we as clinicians,
• 10:26particularly physicians and senior
• 10:28APPS and have have in messaging
• 10:31this to our patients and families,
• 10:34often our patients who were in
• 10:36the comfort of a hospital bed.
• 10:38And I say that relatively have no
• 10:42idea how profound the hospital
• 10:44capacity situation is.
• 10:46And whether they leave at 10
• 10:49or three or four,
• 10:50sometimes they don't understand
• 10:53how significant those few hours
• 10:56can be and impacting the care of
• 10:58other patients who were either
• 10:59waiting for procedures or in the Ed.
• 11:02So I would encourage all of us to
• 11:06round early and often and be very
• 11:09clear in the importance of getting a ride,
• 11:12communicating with family,
• 11:14early discharge planning and making
• 11:17alternative plans to get out of
• 11:20the hospital in a timely way at
• 11:22that on the day of discharge.
• 11:25So that's a hard message for
• 11:27the nursing staff to deliver.
• 11:30It's a hard message for the
• 11:33care management staff.
• 11:34It is really an area where the
• 11:36clinicians need to be leading the way.
• 11:38So I thank all of our teams in advance
• 11:41for your assistance with this.
• 11:47So on that sobering note,
• 11:49I'm going to turn to a more upbeat topic,
• 11:52which is I am thrilled to announce a
• 11:57new technology in radiation oncology.
• 11:59We have Doctor Henry Park with us who
• 12:02is the radiation oncologist who's the
• 12:05medical director of our new Reflexion
• 12:08system that was launched a week or so ago.
• 12:10And without any further commentary,
• 12:12I think I'm going to have Doctor Park
• 12:15tell us about the many benefits that
• 12:17the therapy has for our patients.
• 12:22Well, thank you very much.
• 12:23Can you see my slides?
• 12:26OK, fantastic. All right.
• 12:27So thanks very much.
• 12:29I'm here to talk to you for the
• 12:31next 5 minutes or so about syntax
• 12:34biologically guided radiation
• 12:35therapy also known as BGRT that we
• 12:38can apply with this new machine
• 12:40that we have the Reflection X1.
• 12:41And I I really want to thank everyone
• 12:43who is who is involved in in in
• 12:45helping you know over the last
• 12:46few years get this set up to to to
• 12:49really this really was a team effort.
• 12:52Yeah my disclosures including
• 12:54research funding and consulting
• 12:56from the company external beam RT
• 12:58as long as you know is is often
• 13:00bill it's often given by linear
• 13:03accelerator that produces high
• 13:05energy X-rays to treat cancer.
• 13:07And for each patient we tend
• 13:09to customize dose delivery and
• 13:11distribution using some advanced
• 13:13techniques like IMRT and SBRTI won't
• 13:15go into the full details of what
• 13:16that means right now except to say
• 13:18that it's it's very customized and
• 13:20really for each patient we're able
• 13:22to to deliver very high quality
• 13:23radiation for them with the,
• 13:25with the,
• 13:25with the technology that we already have.
• 13:27This is often guided by daily imaging
• 13:29before every treatment as well to
• 13:31be sure that we're really matching what we,
• 13:33what we think we're doing to what
• 13:35we're actually giving to the patient.
• 13:37Some tumors can move substantially
• 13:39as patients breathe.
• 13:40So just that as the normal
• 13:42respiratory motion happens,
• 13:43especially in the lung and the GI tract,
• 13:46it's very common for Fatimas to
• 13:48breathe to move with with every breath.
• 13:52So the reflection next one is a
• 13:54novel radiation technology that has
• 13:56the capability of using the tumor's
• 13:58own biological PET signal to track
• 14:01the radiation beams in real time.
• 14:03This is known as biologically guided
• 14:05radiation meaning that the tumor
• 14:07itself serves as as the the honing
• 14:09device you know for the the radiation by by.
• 14:12So really as it moves we're able to
• 14:15to to guide the radiation beams to
• 14:17follow along as well in real time.
• 14:20So this is this now is called
• 14:22Syntex by the company.
• 14:24This can this machine can also
• 14:26treat with with standard IMRT and
• 14:28SBRT as well but really designed
• 14:29to be able to function to to to
• 14:32to use the PET signal as well in
• 14:34order to to do the the BGRT.
• 14:38So I know there's a lot of acronyms
• 14:40in radiation oncology but the the
• 14:42basic idea here is if the red is the
• 14:44tumor and brown is a target we we we
• 14:46we can draw out what the tumor is.
• 14:48But the tumor as you breathe in may move
• 14:50up and down or left and right or really
• 14:53any number of directions that we can image.
• 14:55So that moves and then we we cover the
• 14:58whole area where the tumor moves in
• 15:00each for each breath and then we add
• 15:02a little bit of margin around that to
• 15:04account for any potential setup errors.
• 15:06So this at the end is what we
• 15:08actually treat is the brown.
• 15:09However with BGRT,
• 15:10the idea is that you can because
• 15:13you can track the tumor itself,
• 15:15you only need that small setup error
• 15:17margin but not the margin to incorporate
• 15:19the whole respiratory motion.
• 15:20So that's why at the end you see
• 15:22the brown here for BGRT is much
• 15:25smaller than for the SBRT.
• 15:26So the idea behind tracking the PET
• 15:28signal in real time is that we could
• 15:30decrease the size of the radiation field,
• 15:32also increase the confidence of
• 15:34fully hitting our target in case
• 15:36something changes during the treatment
• 15:38itself and also to decrease side
• 15:40the risks of side effects as well.
• 15:43So that's the really the promise
• 15:44of this technology is that we'll
• 15:45be able to do this more and more.
• 15:48Now as you've may have heard,
• 15:50we have the 5th Reflection X1
• 15:52machine in the world here installed
• 15:54back in April of this past year.
• 15:56We're the first ones on the East Coast,
• 15:58the other ones being in Pittsburgh,
• 16:00in Dallas, Los Angeles and Palo Alto.
• 16:03And we've also had the fastest ramp
• 16:05up of the IMRT and SBRT capabilities
• 16:07of any facility with with using
• 16:09this machine to really go into to
• 16:11basically full capacity at this point.
• 16:13Now we've installed the BGRT
• 16:15component of this in December.
• 16:16So just last month the FDA approval for
• 16:20using BGRT was was given in in February.
• 16:23So since then all five of the first
• 16:25five centers have now installed this.
• 16:27Now we've had a ribbon cutting earlier
• 16:29this month and are preparing right now
• 16:31to treat the first patient at Yale who
• 16:33would be the 4th patient overall in
• 16:34the world to be treated with this technology.
• 16:40So indications for reflection
• 16:41S1 are that the IMRT or SBRT. We really,
• 16:44really anyone who gets normal radiation,
• 16:47who gets IMRT or SBRT who needs
• 16:48some kind of complex radiation
• 16:50treatment can be on this machine.
• 16:52There are a few exceptions
• 16:53that that we we can work out,
• 16:55but but basically all tumor types are allowed
• 16:58to get the IMRT or SBRT on this machine.
• 17:01We also have the for the BGRT that's
• 17:03that that's for a smaller population.
• 17:04So only for those with lung or bone lesions,
• 17:08it could be the primary,
• 17:09it could be a met,
• 17:11but has to be treated with five or
• 17:13fewer fractions with a high dose.
• 17:14So with the SPRT paradigm,
• 17:17but just right now in the lung and the bone,
• 17:19but hopefully eventually will
• 17:20be for other sites as well.
• 17:21It has to be hypermetabolic on PET scan
• 17:23of course to be able to follow the PET
• 17:25signal and not all tumors are like that.
• 17:26And eventually the goal and and
• 17:28one of the reasons we really got
• 17:29this machine and we're very excited
• 17:31about this was because of the,
• 17:32the goal to treat multiple
• 17:34metastatic sites at once.
• 17:35We're not quite there yet but they
• 17:38with with stage 4 cancers of all
• 17:40types to be able to treat for for
• 17:42complete metastatic ablation of of
• 17:43maybe more than all of the metastatic
• 17:45disease but even potentially
• 17:47Poly metastatic disease someday.
• 17:48And if the and and and to be ahead
• 17:50of the curve in terms of of this
• 17:53potential indication for for the
• 17:54use of radiation in that capacity
• 17:56similar to what we've seen for Gamma
• 17:58Knife for for brain metastases in
• 17:59that it used to be very restrictive
• 18:01to only one or one to four meds.
• 18:03But now we treat you know we can we
• 18:05can we often routinely treat more than
• 18:0710 metastases at once because of the
• 18:09technology and how it's developed over time.
• 18:11So we're hoping to also be able to
• 18:13do this in the body as well and and
• 18:15and and and really we're in the very
• 18:17early stages now of of developing this.
• 18:18But but we're working very closely
• 18:20with the company to to start simple
• 18:22and then eventually expand to much
• 18:24more complicated indications.
• 18:26From the research side we're
• 18:27very excited as well.
• 18:28We just got this perspective registry
• 18:30called Premier activated through the CTO.
• 18:33It's a multi institutional perspective
• 18:35registry that aims to to really to
• 18:37to study the health related quality
• 18:38of life primarily but also other
• 18:40endpoints as well that I've listed here.
• 18:42And really any patient treated on the
• 18:45reflection whether it's IMRTSPRT or
• 18:47this BGRT syntax can really be for
• 18:50anywhere in the body or they would be
• 18:52treated anyway can be honest registry
• 18:54and and and and and and this is going
• 18:56to be really important to collect
• 18:57this data over time to to really see the the,
• 19:00the value of this technology
• 19:02and then also the potential for
• 19:04industry sponsored grants as
• 19:05well. We've recently executed a master
• 19:07research agreement between Yale University
• 19:09and Reflection Medical that allows us
• 19:11to obtain industry sponsored grants and
• 19:14propose investigated initiated trials.
• 19:15We've already executed 3 grants that
• 19:17we've had approved a little while ago.
• 19:18But now that we have the MRA done,
• 19:21we are looking forward to to to
• 19:23executing these grants and to
• 19:25to actually doing this work.
• 19:26And we're very excited to be able to
• 19:28collaborate with nuclear medicine,
• 19:30with the PET Center,
• 19:31with medical oncology,
• 19:32surgical oncology and many others to for for
• 19:35really innovative research going forward.
• 19:39So in summary,
• 19:40this is a very exciting time for
• 19:41Smilo and a unique opportunity to
• 19:43be early adopters and researchers
• 19:44of this novel technology.
• 19:46Feel free to call me or any of your
• 19:48friendly Yale radiation oncologist at
• 19:49any of the sites if you're wondering
• 19:51if this is right for your patients.
• 19:53We we certainly will need to do our
• 19:56legwork to to to figure out if if
• 19:58your patients may be a candidate.
• 19:59But we are already getting calls from
• 20:01all over the country and even from
• 20:03around the world about this technology.
• 20:04You know people who live in China and
• 20:06and have a family member in New York
• 20:08City who who are interested in if
• 20:09he heard about this and then want to
• 20:11hear more and see if they're eligible.
• 20:13We're always interested in taking those
• 20:14calls and and hearing more about the
• 20:16history and seeing if they if they
• 20:17may be able to to come in and and
• 20:19people are very willing to fly over
• 20:21to to to to to have a consultation if
• 20:23if it seems like it may be appropriate.
• 20:25So I want to really thank all the Y,
• 20:26NHH and SMILO leadership as well
• 20:28as our physicists, asymmetrists,
• 20:30therapists, nurses, engineers,
• 20:32administrators, lawyers,
• 20:34clinical research staff,
• 20:34residents and attendings and many and
• 20:36so many others for your your hard
• 20:38work and collaboration so far in in
• 20:40getting this program off the ground.
• 20:44Thank you very much.
• 20:48Thanks, Henry. That is really it.
• 20:52I it's hard to overstate the excitement
• 20:54that I think we all feel and we look
• 20:57forward to continued updates not
• 20:59only on the clinical front but and
• 21:04the research environment as well.
• 21:10Next up is help me, Renee.
• 21:15Is it Maddie or is it Man Yee or
• 21:18is it Doctor Geary? Doctor Gary?
• 21:23OK, take it away. Doctor Gary.
• 21:25Lots developing on the genetics front.
• 21:33Unmute that. OK. Yes, absolutely.
• 21:36Thank you so much for the opportunity
• 21:38to come and present for a few minutes.
• 21:42I hope everyone can hear
• 21:43me OK and see my slides.
• 21:45So just in a few minutes I want to run
• 21:48through some updates for the cancer
• 21:51genetics and prevention program,
• 21:53give some idea of the signature of
• 21:55care pathways that we have built
• 21:57to help accommodate the patients
• 21:59that that need genetic testing.
• 22:01And then really important to
• 22:03importantly to bring forward some of
• 22:05the new revisions to our processes
• 22:07that have had to happen because of
• 22:09adhering to federal compliance.
• 22:12So I just thought I would take this
• 22:15opportunity though to actually show
• 22:17our cancer genetics and prevention
• 22:19program back to Smilo and others
• 22:22here on the on the meeting as
• 22:24well because it's a real great,
• 22:25really great team and really
• 22:27includes a wealth of expertise.
• 22:30And when we're talking
• 22:31about genetic testing here,
• 22:33we're talking about germline genetic
• 22:35testing and thinking about the hereditary
• 22:38nature of genetic testing As such,
• 22:41we have our team of physicians
• 22:44who are really integral into our
• 22:48processes for genetic testing,
• 22:50genetically based management
• 22:51and high risk care.
• 22:53With myself and I'm a medical oncologist
• 22:56and with a specialty in cancer genetics
• 23:00as well as prostate and Gu cancers,
• 23:02we have Alan Bale who's been
• 23:04with the program for many,
• 23:06many years with the medical genetics
• 23:08expertise and molecular genetics expertise.
• 23:10And we're thrilled that we have had
• 23:13Ellie Prasalaglu who's joined our
• 23:15team who's a breast surgeon and I
• 23:17also a trained OBGYN to lead our
• 23:20breast high risk and genetics efforts.
• 23:22We have a really terrific team of
• 23:25genetic counselors that are shown here
• 23:27with the two lead genetic counselors,
• 23:29Amanda Ganzak and Claire Healy,
• 23:30who are the genetics Co managers and they
• 23:34lead a team of genetic counselors who
• 23:35see patients across the Smilo network.
• 23:37So we are seeing patients as you can
• 23:40see here across the various sites
• 23:43that are really important in terms of
• 23:45helping access to care for patients.
• 23:47We've also recently started a fast
• 23:49track program and our two genetics
• 23:51clinical coordinators are shown here,
• 23:53Carla Cullen Vasquez and Caitlin Shetland.
• 23:56This is a way to help meet the needs
• 23:58and I'll talk about this in just a
• 24:00moment in a more expedited fashion
• 24:02for genetic testing given the rise
• 24:03in some indications like precision
• 24:06medicine and certainly for example
• 24:08for surgical decision making as well.
• 24:10We have our genetic counselling
• 24:12assistants as well who are really
• 24:13integral to help the genetic
• 24:15counsellors and the team in terms
• 24:16of all of the processes that have
• 24:18to happen for genetic testing.
• 24:20And then our high risk clinic is with
• 24:23Sue Smeal who is in APRN and again has
• 24:25been with our program for a very long
• 24:28time to see our high risk patients.
• 24:30So it's a really great team.
• 24:32Please reach out to any of us at any point.
• 24:34We love working with the clinical teams.
• 24:37So the guiding principles for the
• 24:41processes that we've developed and
• 24:43you'll see some of the updates are
• 24:45really ensuring that we adhere to
• 24:47standard of care for genetic testing
• 24:49and the practice of genetic evaluation,
• 24:52ensuring access to care such that
• 24:54we are able to provide genetic
• 24:56services across our catchment areas
• 24:58and in our network and communities
• 25:01and ensuring that we are adherent
• 25:03to federal compliance mandates.
• 25:07So from the physician clinics,
• 25:09if we look at this flow diagram it
• 25:12when a patient is identified that
• 25:13needs to have genetic testing,
• 25:15there are multiple ways that genetic
• 25:18testing and genetic evaluation can
• 25:20be conducted and we've built these
• 25:23different ways such that it can be
• 25:25conducive to the needs of the practice.
• 25:26So for example,
• 25:27one of the pathways and I'll talk
• 25:29in more detail about what these are
• 25:30in just a second would be point
• 25:32of care where the genetic testing
• 25:34can be initiated in the provider
• 25:36practices or it could be through
• 25:38referral upfront to the cancer
• 25:40genetics and prevention program.
• 25:42And we have different referral
• 25:45processes that are set up.
• 25:47So those providers that are on EPIC,
• 25:49whether they're SMILO based providers,
• 25:51non SMILO based providers,
• 25:52but also on EPIC,
• 25:54but also other providers who may not be
• 25:56on EPIC but who we work very closely
• 25:59with can also refer to our program.
• 26:02So the referrals really should be
• 26:04placed in EPIC if you have EPIC as
• 26:06are the most sort of the I'll proof
• 26:08tracking mechanism for referrals
• 26:09coming to the genetics program.
• 26:11And once they are in the genetics
• 26:15program system,
• 26:16we triage them into either the fast
• 26:17track program or the genetic counseling
• 26:19to have a genetic counseling visit.
• 26:21So let me just talk about that for
• 26:23just a second and this will then
• 26:25lead into some of the processes
• 26:27for adhering to compliance.
• 26:28So in the genetic evaluation process,
• 26:31as I mentioned a physician clinics
• 26:33could have the option to think
• 26:36about point of care where here the
• 26:38physician team identifies a patient
• 26:41that needs genetic testing and
• 26:43there's really no question about
• 26:45whether they meet indications.
• 26:46Here the patient can be shown a
• 26:48pre test video that we've developed
• 26:51for the clinical teams and after
• 26:53the video is seen and patient is
• 26:55ensured of their understanding of
• 26:57hereditary cancer genetic testing.
• 26:59The genetic test is ordered by the
• 27:01physician team or their staff.
• 27:03The testing is sent to currently
• 27:05the Yale DNA Laboratory,
• 27:06but we're trying to build it out
• 27:08with additional labs integrated
• 27:09into EPIC to help ease the ordering
• 27:12and enhance the testing capability.
• 27:14Insurance authorization would be
• 27:16complete completed by the lab or
• 27:18by the physician's office and then
• 27:20the patient can be referred on the
• 27:22back end to Cancer Genetics for
• 27:24full results disclosure,
• 27:25particularly if they have a
• 27:27genetic mutation identified.
• 27:29But if the clinician team actually prefers
• 27:31to refer up front to the genetics program,
• 27:33then what we would do is triage
• 27:35once we received
• 27:36the referral to fast track
• 27:38or to genetic counseling.
• 27:39The fast track program as they mentioned
• 27:41is a way to expedite genetic testing
• 27:43for patients that meet clearly meet
• 27:45NCCN guidelines for genetic testing.
• 27:47The volumes of patients that need
• 27:49genetic testing has risen substantially.
• 27:51And so we know we have had to
• 27:54think creatively about how to
• 27:55address the needs for our patients.
• 27:57So here the patients are seen by the one
• 27:59of the genetic clinical coordinators.
• 28:01They're shown the video genetic
• 28:04testing is ordered.
• 28:05Our team completes the insurance
• 28:07authorization if required and then the
• 28:09results are disclosed by the genetics
• 28:11clinical coordinator or a genetic counselor,
• 28:13certainly by genetic counselor
• 28:14if there's a mutation.
• 28:15These results are discussed
• 28:17within the team itself.
• 28:18So these genetics clinical coordinators
• 28:20have the full team input in terms of
• 28:24results disclosures or we triage the
• 28:26patient to see a genetic counselor.
• 28:27And here it's for patients really
• 28:29that are more complex,
• 28:31whether it's unclear that they meet
• 28:33NCCN guidelines for testing or really
• 28:35mandated to see a genetic counselor
• 28:37with which some insurances do do.
• 28:39And then they're seen by
• 28:40the genetic counselor.
• 28:41The testing is ordered and the
• 28:43insurance authorization is conducted
• 28:45by our team and the results are
• 28:47disclosed by the genetic counselor.
• 28:49Now what has transpired over the
• 28:51past year is a ruling by CMS that
• 28:54stated that genetic tests must be
• 28:57ordered by the physician or APP
• 29:00who is treating and managing the
• 29:03patient's medical problem or problems.
• 29:05And they've clearly stated that tests
• 29:07ordered by a genetic counselor would
• 29:09not be considered reasonable or
• 29:12medically necessary per this federal.
• 29:14So this really you know it,
• 29:17it is what it is and we've had to
• 29:20adapt our processes to then meet
• 29:23the federal compliance mandate.
• 29:26So based on this,
• 29:26what we've had to do is point of care
• 29:29doesn't change of course because
• 29:30that's happening in the physician
• 29:32offices who are managing and treating
• 29:34the patients and the testing is
• 29:36being ordered by the physician there.
• 29:38Where the processes had to change was
• 29:40for fast track and for genetic counseling.
• 29:42So in this process for
• 29:44the Fast track program,
• 29:46these are predominantly internal
• 29:48to Smilo referring providers.
• 29:50And So what we have done is set up
• 29:53processes such that the genetics
• 29:55team will input information for
• 29:58genetic test ordering and pend
• 30:00it in EPIC for the referring Dr.
• 30:02to sign.
• 30:02So one thing I'd like everyone
• 30:04to just please be mindful of it.
• 30:06In EPIC you're going to start to see
• 30:09genetic test orders that need to be
• 30:11signed if you're the referring Dr.
• 30:13and of course testing cannot
• 30:15be completed without those,
• 30:17those sign offs in EPIC.
• 30:20The other thing we've done is
• 30:22for the patients that are seen
• 30:24by a genetic counselor,
• 30:25these patients can be a kind of in a
• 30:29multitude of you know referral bases.
• 30:31And So what we've done is created
• 30:33different ways that we're handling
• 30:36this part of the test ordering.
• 30:37One is our genetics physicians are
• 30:39seeing many of these patients and
• 30:41combined visits with the genetic
• 30:42counselors and then we are signing
• 30:44off on the genetic test orders.
• 30:47Another way that we're handling this is
• 30:49in tandem with our genetics APRN with
• 30:52SUSHMIL where the genetic counselor
• 30:54sees the patient first and then Sue
• 30:56will see the patient and be able to
• 30:58sign the order for genetic testing.
• 31:00There are still going to be patients
• 31:02that need genetic test orders
• 31:04signed by the referring provider.
• 31:06So again, this would be where we would
• 31:09have to upload the result into EPIC and
• 31:11have the referring provider sign off on it.
• 31:14If there's a referring
• 31:15provider who is not on EPIC,
• 31:16these are patients that we'd be
• 31:17seeing by the genetics physicians
• 31:19and we would be signing those orders.
• 31:21So we've had to develop multiple
• 31:23processes for signing up orders.
• 31:24So please keep an eye out in your
• 31:26EPIC in baskets for these things
• 31:28coming your way for signature.
• 31:30One other thing that we have to be
• 31:32mindful of is that there are certain
• 31:35insurances that require authorization
• 31:37for genetic testing to be covered.
• 31:39Some of these are shown here Tricare
• 31:41Medicaid and Aetna as some of the key
• 31:44insurance plans that require insurance
• 31:46authorization to be completed to pay.
• 31:49What happened is that those insurance
• 31:51authorizations form once again have to
• 31:53be signed by the referring provider.
• 31:55So for example Medicaid those
• 31:57signatures have to be fresh signatures.
• 32:01We can't apply a signature to those
• 32:04authorization forms on our end.
• 32:05So we are having to re contact are
• 32:08the referring doctors to sign these
• 32:11insurance authorization forms for Medicaid,
• 32:13for Tricare and Aetna.
• 32:15We probably are going to be able to
• 32:17sign the insurance forms if we get
• 32:19a signature from the referring Dr.
• 32:22So you're probably some of you are
• 32:24probably starting to see some emails
• 32:25coming back saying we need your
• 32:27signature on this form and or please
• 32:29provide your signature on a blank piece
• 32:31of paper and we'll apply it you know
• 32:34for these insurances to get these authorized.
• 32:36Obviously this is really time
• 32:38sensitive for these patients because
• 32:40otherwise they could get a bill,
• 32:42you know,
• 32:42for their genetic testing and it could
• 32:44be hundreds and hundreds of dollars.
• 32:45So any way that we can work together to just
• 32:49start collecting signatures would be huge.
• 32:53I can talk to Doctor Billingsley,
• 32:55you know,
• 32:55at a different point on how to think
• 32:57about doing this because we obviously
• 32:58don't want to overburden clinical teams,
• 33:00but at the same time we have to get these,
• 33:01you know,
• 33:02insurance authorizations signed off,
• 33:04So changes in process,
• 33:06but all for the sake of patient care.
• 33:08So you know,
• 33:09just making sure that we keep
• 33:10that front of mind.
• 33:11So we have set up an e-mail specifically
• 33:16related to this compliance process.
• 33:18We've sent out one general e-mail already
• 33:21updating everyone about these processes.
• 33:23Please e-mail this e-mail if
• 33:25you have questions.
• 33:26Of course, you could e-mail me
• 33:28directly as well and we're going
• 33:30around to different clinical teams
• 33:31to give these presentations.
• 33:33But we do look forward to working with you.
• 33:35And thank you again for allowing
• 33:37some time to bring this forward
• 33:39here for this town Hall. Thank you,
• 33:45Doctor. Gary, thank you.
• 33:47I know you and your team have been
• 33:51working feverishly to bring this
• 33:53process forward and it just shows how
• 33:55complicated our work is in a shifting
• 33:58compliance and regulatory landscape.
• 34:00I know there are going to be other questions.
• 34:04You know, I think Renee will be
• 34:07circulating the e-mail and I know
• 34:09you will be coming back to meet
• 34:11with teams as we move forward.
• 34:14So great work, Manny.
• 34:16Thank you for joining us.
• 34:18As always, we are incredibly grateful for
• 34:22the partnership with our pharmacy colleagues.
• 34:25I know you're going to be updating us
• 34:27on early release of medication orders.
• 34:28So I think in the interest of
• 34:31time press ahead.
• 34:32Yes, I will share my screen.
• 34:37OK everyone thank you for having me here
• 34:41to share the early release of medication
• 34:44procedure few before the holiday.
• 34:47There's an e-mail had sent out to share
• 34:51everybody about early release process.
• 34:55Sorry I cannot advance my slides.
• 35:01OK, here we go.
• 35:03Yeah. So few weeks ago
• 35:04we have shared the emails to communicate the
• 35:07early release standard operation procedure.
• 35:11This early release SOP is not new and and
• 35:14in fact has been implemented since 2013.
• 35:18We just share with everybody with the update
• 35:21and but we take the opportunity here to
• 35:25reiterate this topic and we talk about why
• 35:28we need early release and how does it work.
• 35:31And as you can see this graph,
• 35:34it's clearly illustrated that there
• 35:36is influx order coming through
• 35:38within a short period of time.
• 35:40So maturity order for the of the
• 35:42day comes in within three hours.
• 35:45So this can lead to a in efficient workflow
• 35:48and prolonged patient waiting time.
• 35:54The benefit of the early release process
• 35:57has been shown in other Cancer Center
• 35:59to it can reduce patient wait time,
• 36:02improve workflow and patient experience
• 36:05more importantly can help us to
• 36:08improve infusion chair utilization.
• 36:11So we since we have implemented this
• 36:15SOP actually other cancer centre have
• 36:17reached out to us over the years
• 36:20to share our experience and also
• 36:22get a copy of our SOP to implement
• 36:25it to their cancer there too.
• 36:27So in general medication selected
• 36:29for early release,
• 36:31it's considered as IV administrator
• 36:33supportive care medications
• 36:35such as pre medication,
• 36:37anti medic hydration medication with
• 36:40independent laboratory results such
• 36:43as Tritusumab treatment regimen
• 36:46containing consecutive treatment
• 36:48days such as epoch days 2 to 4,
• 36:52etoposides days 2:00 to 3:00.
• 36:57So how does it work and this is
• 36:59how we work that work for during
• 37:02the proceeding treatment day,
• 37:04nurses and pharmacists in the
• 37:06clinic will collaborate to
• 37:07determine appropriate medication
• 37:09for early release by reviewing
• 37:11the next treatment day schedule.
• 37:13The nurse performs independent
• 37:15review and release the medication.
• 37:18The pharmacist perform independent
• 37:20review and verify the medication.
• 37:23Then the pharmacy will prepare
• 37:25the medication in advance with the
• 37:28consideration of drug stability
• 37:30and cost on the treatment day prior
• 37:33to administration that a different
• 37:35infusion nurse will perform a second
• 37:38review in addition to confirm with
• 37:40the provider the plan to treat so.
• 37:43As you can tell all these procedure
• 37:46has not changed any of the standard
• 37:49steps that for safety check.
• 37:51So but it's to shift the some of
• 37:53the work the day before to allow
• 37:55the medication to be ready before
• 37:58the patient come into treatment.
• 38:02So we'll leave to any question.
• 38:09Thank you, Manny.
• 38:10I think there will likely be
• 38:12some questions in our Q&A.
• 38:14So I'm going to defer until that
• 38:18time like Doctor Gary's presentation,
• 38:20this is incredibly important and I'm
• 38:23hoping that you and your team mates
• 38:26will kind of make the rounds among the teens.
• 38:29I'll just share from my perspective
• 38:31there are a few things that we can
• 38:34do that will improve patient and
• 38:36nursing staff in few experience in
• 38:38the infusion centers more than the
• 38:41ability to get drugs to patients
• 38:43quickly when they get in their chairs.
• 38:46So this isn't really valuable work.
• 38:50So more to come next.
• 38:53Maddie Kaler has done amazing work
• 38:56with her team over the past year
• 38:59since she's been in this role,
• 39:02building our portfolio of supportive
• 39:05services including integrative medicine,
• 39:07Reiki, nutrition,
• 39:08a variety of things which enhance the
• 39:12quality of life and experience for
• 39:14patients along their care journey.
• 39:17So Maddie's joined us today to
• 39:19give us a variety of updates.
• 39:21Thank you.
• 39:26All right. Thank you for having me.
• 39:28I'm very excited to speak with you about
• 39:31the supportive care program here at Smilo.
• 39:34And I have been leading this team
• 39:36with my clinical colleagues,
• 39:38Doctor Jennifer Capo and
• 39:41Executive leadership Sonia Gross.
• 39:42Also, I'm very excited to speak
• 39:44with you about the the team.
• 39:46So first and foremost, just a little bit
• 39:49of some background on supportive care.
• 39:51The multinational association of
• 39:53supportive care and cancer defines
• 39:56supportive care as the prevention
• 39:58and management of the adverse
• 40:00effects of cancer in its treatment.
• 40:02This definition does include the
• 40:04management of physical and psychological
• 40:06symptoms and side effects across the
• 40:09continuum of the cancer journey.
• 40:11Which is really excited,
• 40:12really exciting that they define the
• 40:14whole continuum of cancer care because
• 40:17that's exactly what our team does and
• 40:19I'm very excited to kind of speak with
• 40:21you a little bit more about it today,
• 40:23kind of tapping into the
• 40:25history of supportive care.
• 40:26Supportive care really became kind
• 40:29of well known kind of in the 1960s
• 40:32and seventeen 1960s and 70s when
• 40:36chemotherapy became more widely
• 40:38used in oncology treatment and it
• 40:41really focused really in the the
• 40:44medical side effects of cancer.
• 40:46And over time we've actually opened
• 40:48up that definition to include a
• 40:50lot of different facets as we look
• 40:52at whole patient care.
• 40:54We're taking into account now
• 40:56the emotional well-being,
• 40:57the psychosocial well-being,
• 40:59the spiritual health and the
• 41:01physical health of the patient.
• 41:03So supportive care is really
• 41:05encompassing all of these facets of
• 41:08of cancer care in oncology patients.
• 41:10So in research supportive care,
• 41:13effective supportive care has actually
• 41:14been seen to improve the quality of life,
• 41:18decrease the symptom burden and then
• 41:22increase survival, increase survival.
• 41:24And then as it relates to
• 41:27hospital operations,
• 41:28effective supportive care has also been
• 41:30seen to decrease hospital admissions and
• 41:33decrease emergency department visits.
• 41:35So in aligning that with some
• 41:38of the surge issues that we are
• 41:41now seeing at the hospital,
• 41:43it really is you know holistically
• 41:45looking at the the whole patient
• 41:47and in preventative care as well.
• 41:49So we were fortunate enough to
• 41:52receive a grant from the Milbank
• 41:54Foundation to launch a supportive
• 41:57care access program here at Smilo.
• 41:59And this program has now been
• 42:01live for about a year and a half,
• 42:03two years now and we are extremely
• 42:06excited to partner with our
• 42:08clinical colleagues in making this
• 42:10team come a reality.
• 42:12So the supportive care team
• 42:14is a team of lay navigators.
• 42:16So it's non clinical navigators that
• 42:19really conduct phone screenings with
• 42:22patients as they complete their new
• 42:24patient visit here at Smilo and
• 42:26assess where they're at and kind of
• 42:29understand if they have any needs
• 42:31that we can potentially meet with our
• 42:34supportive programs that we have here.
• 42:37So on this screen you can see that
• 42:39patients that can actually come to
• 42:41us in two different ways and that's
• 42:44they themselves can self refer to
• 42:46us or where where you all come
• 42:48in in partnership with us is
• 42:51that our clinical teams can refer to
• 42:54us in EPIC which is super important.
• 42:57So we conduct phone screenings
• 42:59with patients and then we assess
• 43:01for eligibility for 15 programs.
• 43:04We have here at Smilo that you can
• 43:06see on the lower half of the of the
• 43:09screen and we will refer to these
• 43:11teams accordingly if patient's
• 43:13needs align with eligibility and
• 43:15criteria for all of those 15 teams.
• 43:18And what this does is not only
• 43:20does it meet the patient's needs,
• 43:22but it also does increase the
• 43:24utilization of our wonderful supportive
• 43:26care programs that we have here.
• 43:28I think it's important to note that a
• 43:30lot of the patients didn't know that we
• 43:32had some of these supportive care programs.
• 43:34So it really is a great means to
• 43:37to advocate for these programs and
• 43:39actually help increase the education
• 43:41for patients on the supportive
• 43:44care programs that we do have here.
• 43:46So when you refer to us in EPIC,
• 43:50you can refer to us in two different ways.
• 43:52We've made it easy so you can find
• 43:55us in a smart set as I've outlined
• 43:57on this screen and this,
• 43:59This smart set is available in the Smilo
• 44:02Supportive Care Referrals smart set.
• 44:04So we're an easy check box for you,
• 44:08but you can also find us when
• 44:10you type in Smilo Supportive Care
• 44:12referral services as well.
• 44:14And this actually is a very important
• 44:16way that you can get your patients
• 44:19in touch with with us because
• 44:21this serves as the starting point
• 44:23for our contact with patients.
• 44:25When we reach out to patients usually
• 44:27at the onset of their diagnosis,
• 44:30we're not really expecting them to
• 44:31be open minded or interested in any
• 44:33any of the supportive care programs
• 44:35at that point because we understand
• 44:37that they may be overwhelmed with
• 44:40a new oncology diagnosis.
• 44:42However, when we usually talk with patients,
• 44:44we give them the option for a later
• 44:47call back and we've noticed that
• 44:49you know two months in three months
• 44:51into their oncology treatment,
• 44:53they really are more open minded
• 44:55understanding and it will actually
• 44:58accept referrals as they are
• 45:00encountering different challenges
• 45:01along their cancer treatment journey.
• 45:04So the referral and EPIC from you
• 45:05all is really a great starting point
• 45:07for a relationship that we have
• 45:09with the patient throughout their
• 45:10continuum of their treatment plan.
• 45:12So your I can't under site that enough
• 45:15that truly the partnership with our
• 45:17clinical teams is very important
• 45:19in making sure that patients have
• 45:21what they need from an outpatient
• 45:23perspective throughout the whole
• 45:26duration of their oncology treatment.
• 45:29So we are located on site.
• 45:31For those of you who are interested or
• 45:35in the area or would like to stop by,
• 45:37we are located in the Patient and
• 45:40Family Resource Center on NP1.
• 45:42Our doors open Monday through Friday,
• 45:448:00 to 4:30.
• 45:45I encourage you to come on in our great
• 45:48supportive Care Referral Coordinator.
• 45:50Her name is Solitaire Adorno
• 45:52and she is a wealth
• 45:53of information for all
• 45:55things supportive care.
• 45:56So if you have patients who are
• 45:58interested in learning a little bit
• 46:00about everything, our door is open.
• 46:01If you yourself would like to learn anything
• 46:04about the supportive care programs,
• 46:06the Patient Family Resource Center
• 46:08is a good first place to stop by.
• 46:10We have a wealth of resources
• 46:12both written and and and printed
• 46:15material for you all to take
• 46:17and and read at your leisure.
• 46:20But we're we also do have a centralized
• 46:23phone and e-mail address so that's
• 46:25how patients find us usually.
• 46:28We do have rack cards.
• 46:29So for any of your clinics or areas
• 46:31if you would like our information,
• 46:32I would be happy to send you
• 46:35interoffice use some rack cards.
• 46:37But we also do have an online
• 46:38website too where it highlights a
• 46:39little bit about about our teams,
• 46:41but it also goes and takes a deeper
• 46:43dive into the 15 teams that we
• 46:45are fortunate enough to support.
• 46:47So thank you all for your partnership
• 46:49so far and this team is growing
• 46:52and we're really excited to partner
• 46:55with all of our clinical colleagues
• 46:57across all disease disk plans and
• 46:59continue to educate patients and
• 47:01put them in touch with the with
• 47:04the supportive care programs here.
• 47:06So with that I'm open for any questions.
• 47:11Maddie,
• 47:11there is a couple questions in the chat,
• 47:13one for clarification on
• 47:15what patients are covered.
• 47:17It seems that someone's asking about
• 47:20Bridgeport in particular and the other is
• 47:23in relation to a financial counseling.
• 47:25Is there any of these services that
• 47:27provide any financial counseling?
• 47:31Yeah, so our financial or our
• 47:33supportive care resources,
• 47:34we have completed our financial assistance
• 47:38kind of how TOS and things of that sort.
• 47:41So we do have a partnership with
• 47:42our finance and billing office.
• 47:44So for patients who are inquiring about
• 47:46payment plans and things like that,
• 47:48we can definitely put them in touch
• 47:51with with our colleagues in the SBO.
• 47:53I should say we are eligible
• 47:55for all patients of Smilo that's
• 47:57across the Smilo network,
• 47:59across all Smilo, SMILO sites as well.
• 48:03Everyone can utilize us.
• 48:10I think there's one other
• 48:13question from Paula.
• 48:15Thank you, Paula. She asked Mehdi,
• 48:18within the 15 services available to
• 48:20our SMILO patients, is there any,
• 48:22did we cover this financial counseling?
• 48:24Yes. OK, thank you.
• 48:28Could I ask doctor Gary one question?
• 48:36What,
• 48:40how, how can our referring physicians
• 48:46is there anything we can do or the APPS
• 48:49can do to engage with payers up front
• 48:55or early on so that you and your team
• 48:59are not doing as much back end work.
• 49:03Is there any kind of, in other words,
• 49:07preemptive documentation that we
• 49:10can be submitting with the with the
• 49:13order to to kind of short circuit
• 49:17the review process so it becomes
• 49:20so it's less laborious? Yeah,
• 49:22no, it's a really great question.
• 49:24I mean that's what we've been
• 49:28thinking about to be truthful.
• 49:31It's a subset of the patients that
• 49:33have genetic testing ordered that
• 49:35need those authorizations done.
• 49:37You know it's not all of them,
• 49:39the laboratories are the ones
• 49:41that submit to insurances, right.
• 49:44So it's happening kind of outside
• 49:45of our domain for coverage of the
• 49:49cost for right now it's those
• 49:51kind of three big insurance plan.
• 49:52I think what would help us the most
• 49:54is if we could collect signatures,
• 49:58it seems like that's a laborious process.
• 50:01But if we could connect with say
• 50:03clinic nurses or other clinical staff
• 50:05who could garner the signatures for
• 50:08us of the physicians in that team,
• 50:10that would be a huge help to us because
• 50:14it is a subset of the patients that when
• 50:15it arises it's like suddenly time sensitive,
• 50:17you know, so that way we could,
• 50:21we could just go forward, you know,
• 50:22so that's one thing we've been trying to do.
• 50:25So if there's a way to collect that
• 50:27information of who are the key individuals
• 50:29per clinic for us to connect with,
• 50:31that would be a really,
• 50:33really helpful thing for us And then we
• 50:35would be able to make make those links,
• 50:36get those signatures and
• 50:37have them on our files,
• 50:39you know, to do that.
• 50:40Aside from that,
• 50:41I can ask our, you know,
• 50:43lead genetic counselors as well to
• 50:44your more directly to your question,
• 50:46if there's other ways around it.
• 50:50That's helpful. Thank you.
• 50:51I think we can work on those things.
• 51:04No, I I'm going to take moderator's privilege
• 51:08and ask one other question. Doctor Park,
• 51:16we refer as clinicians, you know a host
• 51:19of different patients to the department.
• 51:25Is it is it at all helpful if we
• 51:29ask specifically for biologic
• 51:30guided radiation therapy,
• 51:32if we're if we think it may be helpful
• 51:35or do we just leave it to you and
• 51:37your team to to really decide what
• 51:40patients would be most appropriately
• 51:42treated with that therapy? Yeah,
• 51:45that's a very good question.
• 51:46You know there are a lot of
• 51:47restrictions at least at this point
• 51:49in terms of who's eligible or not.
• 51:50So certainly if you would
• 51:51like to bring it up there,
• 51:53you're more than welcome to ask about that.
• 51:55When you're making a referral
• 51:56or the to call the person that
• 51:58you that you're referring to,
• 51:59just ask about it.
• 52:01But at the same time,
• 52:02you know there's a lot of legwork
• 52:03on our end that sometimes we
• 52:05don't know right up front either.
• 52:06Sometimes we can make a determination
• 52:08based on what's available already,
• 52:09but sometimes we we do need to go
• 52:10through the process a little bit
• 52:12in terms of some of the imaging
• 52:13only sessions and some other the
• 52:15the simulation sessions to to
• 52:16model things before we really
• 52:17know if they're eligible.
• 52:18So I think the important thing
• 52:20is when you're referring to not
• 52:22necessarily promise the patient that
• 52:23they will be getting BGRT since many
• 52:26of them won't actually be eligible.
• 52:28But that being said,
• 52:29if you'd like to to to to mention
• 52:31that this may be a possibility
• 52:32for them without promising it,
• 52:34that certainly could be helpful.
• 52:38Terrific.
• 52:46Let me just make sure we're not
• 52:48missing any questions. I think we,
• 52:53we do have some follow up work to do
• 52:56with Bridgeport Hospital and I think
• 52:59we've covered a lot of territory.
• 53:02Thank you to all of our panelists.
• 53:04Tracy, is there anything I've missed?
• 53:07Do you any, any closing comments or
• 53:09things to add we could maybe give
• 53:11people a few minutes back this evening.
• 53:14I'm sure they would appreciate that.
• 53:15No, I I just want to thank
• 53:16everyone for their time.
• 53:17I think these were great topics
• 53:19and you know hopefully we'd also
• 53:21like to ask if people have things
• 53:23that they would like to hear about,
• 53:25please you know e-mail Kevin or myself
• 53:26or Lori or Eric and let us know.
• 53:28We really want to make this engaging
• 53:30and useful to the participants,
• 53:32so we'd be happy to hear your
• 53:34feedback on that as well.
• 53:39And Tracy, if I could just add to
• 53:41that because we've talked about
• 53:43this recently topics, but also
• 53:46we know that it's hard to find any
• 53:49great time that works for everybody.
• 53:51So we would love to get
• 53:53feedback on other ways
• 53:55in which we can
• 53:58reach folks
• 54:00to to to
• 54:01be able to generate as much
• 54:04involvement engagement as as
• 54:05possible. We do record these
• 54:08and would strongly
• 54:09encourage that you encourage your teams,
• 54:12your colleagues to take the time
• 54:15to go in and and look at
• 54:17what's been discussed
• 54:18because it's there is a lot of really
• 54:20important information that is shared and
• 54:23we certainly experienced that this
• 54:26evening. So that would be another
• 54:28area that would be of interest
• 54:30for us to hear about.
• 54:38Thank you everyone.
• 54:39Have a great evening.
• 54:41We appreciate all you do.
• 54:44Thank you. Bye, bye.